Provider Demographics
NPI:1710434022
Name:LEE, DONG HEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DONG HEE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:PHILLIP
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1317 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021-1101
Mailing Address - Country:US
Mailing Address - Phone:213-683-0522
Mailing Address - Fax:
Practice Address - Street 1:1317 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021-1101
Practice Address - Country:US
Practice Address - Phone:213-683-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20432225XM0800X, 225X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program