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General NPI Number Information
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NPI Number | 1902974827
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Entity Type | Individual
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Provider Name | KYUNG SHIN LEE LCSW, BCD
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1440 E. 1ST. ST. STE. 100
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City | SANTA ANA
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State | CA
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Zip | 92701
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Country | US
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Telephone | 714-953-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 18 ASPEN TREE LANE
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City | IRVINE
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State | CA
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Zip | 92612
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Country | US
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Telephone | 949-786-6067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LZ12728
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License Number State | CA
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