Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 20432 | CA |
N | 225XM0800X | Mental Health | 20432 | CA |
NPI | 1710434022 |
---|---|
Provider Name | Dong Hee Lee |
First Address | Los Angeles, CA 90021-1101 |
Second Address | Los Angeles, CA 90021-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2016 |
Last Update Date | 30/09/2019 |