=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942081815
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KI YEON LEE-SANDINO BCBA, LBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2023
-----------------------------------------------------
Last Update Date | 12/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 EARLE OVINGTON BLVD STE 600
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11553-3622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-621-2681
-----------------------------------------------------
Fax | 516-621-2403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10440 QUEENS BLVD APT 11Y
-----------------------------------------------------
City | FOREST HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11375-8144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-617-2009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 003149
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------