MEDICARE: SEULBI 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	363A00000X	Physician Assistant	61767	CA

General Provider Information

NPI Number	:	1942937792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEULBI LEE

Provider Business Mailing Address
First Line	:	1 PACE PLZ
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-1502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 W SUNSET BLVD STE C110
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-2439
Country	:	US
Telephone Number	:	213-412-0400
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	04/08/2026

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Directions to “ SEULBI LEE ” Practice Location

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