Provider Demographics
NPI:1336474576
Name:LEE, YOUNG SUN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG SUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:YOUNG
Other - Middle Name:S
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:11712 MOORPARK ST STE 105
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2156
Mailing Address - Country:US
Mailing Address - Phone:818-900-5152
Mailing Address - Fax:
Practice Address - Street 1:11712 MOORPARK ST STE 105
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2156
Practice Address - Country:US
Practice Address - Phone:818-900-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical