Provider Demographics
NPI:1083000277
Name:LEE, SUNGEUN MELANIE (MD)
Entity Type:Individual
Prefix:
First Name:SUNGEUN
Middle Name:MELANIE
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUNG-EUN
Other - Middle Name:MELANIE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6345 BALBOA BLVD STE 365
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1511
Mailing Address - Country:US
Mailing Address - Phone:818-643-5082
Mailing Address - Fax:818-643-7098
Practice Address - Street 1:6345 BALBOA BLVD STE 365
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1511
Practice Address - Country:US
Practice Address - Phone:818-643-5082
Practice Address - Fax:818-643-7098
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1451882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty