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NPI Code Detail

MEDICARE: KEVIN JOONHO LEE PSYD

MEDICARE: KEVIN JOONHO LEE PSYD
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
1103TC0700XClinical Psychologist136591IA

General Provider Information

NPI Number : 1265050363
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN JOONHO LEE PSYD
Provider Business Mailing Address
First Line : 26001 REDLANDS BLVD
Second Line :
City : REDLANDS
State : CA
Zip : 92373-7762
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 26001 REDLANDS BLVD
Second Line :
City : REDLANDS
State : CA
Zip : 92373-7762
Country : US
Telephone Number : 98-947-6879
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2020
Last Update Date : 02/11/2026

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Directions to “ KEVIN JOONHO LEE PSYD” Practice Location

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