Provider Demographics
NPI:1619019445
Name:LEE, HOSUK (OTR)
Entity Type:Individual
Prefix:
First Name:HOSUK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 S VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3155
Mailing Address - Country:US
Mailing Address - Phone:213-820-9546
Mailing Address - Fax:
Practice Address - Street 1:8121 VAN NUYS BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5105
Practice Address - Country:US
Practice Address - Phone:818-392-8115
Practice Address - Fax:818-357-5574
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8004225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOT8004BMedicare PIN
CAWOT8004CMedicare PIN