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NPI Code Detail

MEDICARE: SOONJA C LEE PSYCHOLOGIST

MEDICARE: SOONJA C LEE PSYCHOLOGIST
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
1103T00000XPsychologistPSY17203CA

General Provider Information

NPI Number : 1265714638
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOONJA C LEE PSYCHOLOGIST
Provider Business Mailing Address
First Line : 4221 WILSHIRE BLVD STE 311
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-3537
Country : US
Telephone Number : 323-930-9600
Fax Number : 323-930-9602
Provider Business Practice Location Address
First Line : 4221 WILSHIRE BLVD STE 311
Second Line :
City : LOS ANGELES
State : CA
Zip : 90010-3537
Country : US
Telephone Number : 323-930-9600
Fax Number : 323-930-9602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2011
Last Update Date : 09/12/2011

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Directions to “ SOONJA C LEE PSYCHOLOGIST” Practice Location

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