Provider Demographics
NPI:1700537677
Name:LEE, NICHOLAS HYUN WOO (BCBA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:HYUN WOO
Last Name:LEE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ARDMORE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0109
Mailing Address - Country:US
Mailing Address - Phone:949-648-8841
Mailing Address - Fax:
Practice Address - Street 1:83 ARDMORE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0109
Practice Address - Country:US
Practice Address - Phone:949-648-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABACB496858103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABACB496858OtherBACB