MEDICARE: DR. ANN EUN LEE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY19523	CA

General Provider Information

NPI Number	:	1154546554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN EUN LEE PHD

Provider Business Mailing Address
First Line	:	2600 REDONDO AVE FL 6
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2325
Country	:	US
Telephone Number	:	562-256-1270
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 REDONDO AVE
Second Line	:	SUITE 181
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2656
Country	:	US
Telephone Number	:	562-673-9655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	01/24/2020

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