MEDICARE: YOONJIN LEE MSW

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	1041C0700X	Clinical Social Worker	ASW 20411	CA

General Provider Information

NPI Number	:	1972628683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOONJIN LEE MSW

Provider Business Mailing Address
First Line	:	532 CONCORD ST
Second Line	:	#203
City	:	GLENDALE
State	:	CA
Zip	:	91203-1576
Country	:	US
Telephone Number	:	818-545-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	8616 LA TIJERA BLVD
Second Line	:	STE #200
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3944
Country	:	US
Telephone Number	:	310-337-1550
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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