Healthcare Provider Details

I. General information

NPI: 1073454898
Provider Name (Legal Business Name): YE JI LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YE JI KIM

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 NORWALK BLVD
SANTA FE SPRINGS CA
90670-3343
US

IV. Provider business mailing address

233 ORANGEFAIR MALL
FULLERTON CA
92832-3038
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: