Provider Demographics
NPI:1164654265
Name:LEE, HYEMIN
Entity Type:Individual
Prefix:MISS
First Name:HYEMIN
Middle Name:
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 1:1717 ORANGEWOOD AVE. STE I
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2040
Mailing Address - Country:US
Mailing Address - Phone:714-712-8340
Mailing Address - Fax:
Practice Address - Street 1:1717 W ORANGEWOOD AVE # 1
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2040
Practice Address - Country:US
Practice Address - Phone:714-712-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-22
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 66175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health