Provider Demographics
NPI:1407324171
Name:LEE, SEUNGJOO (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:SEUNGJOO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:SEUNGJOO
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SEUNGJOO ELENA LEE
Mailing Address - Street 1:314 N ARDMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4414
Mailing Address - Country:US
Mailing Address - Phone:213-924-1972
Mailing Address - Fax:
Practice Address - Street 1:18555 VENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4192
Practice Address - Country:US
Practice Address - Phone:818-213-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist