Provider Demographics
NPI:1427178680
Name:MARTIN, WANSOON LEE (MD)
Entity Type:Individual
Prefix:
First Name:WANSOON
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:LEIGH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10850 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4305
Mailing Address - Country:US
Mailing Address - Phone:310-470-7100
Mailing Address - Fax:310-470-7110
Practice Address - Street 1:10850 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4305
Practice Address - Country:US
Practice Address - Phone:310-470-7100
Practice Address - Fax:310-470-7110
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0517042084P0804X
CAA517042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry