Provider Demographics
NPI:1013646280
Name:LEE, SUSAN SOOJIN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SOOJIN
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7212 ORANGETHORPE AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-4667
Mailing Address - Country:US
Mailing Address - Phone:714-449-1125
Mailing Address - Fax:
Practice Address - Street 1:7212 ORANGETHORPE AVE STE 8
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4667
Practice Address - Country:US
Practice Address - Phone:714-449-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health