MEDICARE: MICHELLE MINKYUNG LEE

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	235Z00000X	Speech-Language Pathologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821605627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MINKYUNG LEE

Provider Business Mailing Address
First Line	:	6060 W MANCHESTER AVE STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4266
Country	:	US
Telephone Number	:	909-518-1968
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 W MANCHESTER AVE STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4266
Country	:	US
Telephone Number	:	909-518-1968
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	04/21/2025

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Directions to “ MICHELLE MINKYUNG LEE ” Practice Location

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