Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 11412 | CA |
NPI | 1306139175 |
---|---|
Provider Name | Hyojoo Susan Lee |
First Address | Los Angeles, CA 90005 |
Second Address | Los Angeles, CA 90006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 26/05/2011 |