Healthcare Provider Details

I. General information

NPI: 1548414766
Provider Name (Legal Business Name): CHRISTINE MYUNG SUNG LEE MA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 S BASCOM AVE STE 202
SAN JOSE CA
95124-2675
US

IV. Provider business mailing address

3880 S BASCOM AVE STE 202
SAN JOSE CA
95124-2675
US

V. Phone/Fax

Practice location:
  • Phone: 408-535-0162
  • Fax: 408-371-9193
Mailing address:
  • Phone: 408-535-0162
  • Fax: 408-371-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: