Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS24527 | CA |
NPI | 1003068156 |
---|---|
Provider Name | Jungmi Lee |
First Address | Pomona, CA 91767-2722 |
Second Address | Pomona, CA 91767-2722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 24/09/2013 |