Provider Demographics
NPI:1588006290
Name:LEE, SEUNG JIN (MFT-TRAINEE)
Entity Type:Individual
Prefix:
First Name:SEUNG JIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MFT-TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SO. LAFAYETTE PARK PLACE 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:LA
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-252-2100
Mailing Address - Fax:213-383-3146
Practice Address - Street 1:520 SO. LAFAYETTE PARK PLACE 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:LA
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-252-2100
Practice Address - Fax:213-383-3146
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program