Provider Demographics
NPI:1912425836
Name:LEE, YOON JUNG
Entity type:Individual
Prefix:
First Name:YOON
Middle Name:JUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8749 WATSON ST APT D
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5941
Mailing Address - Country:US
Mailing Address - Phone:714-318-2137
Mailing Address - Fax:
Practice Address - Street 1:7212 ORANGETHORPE AVE STE 8
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4667
Practice Address - Country:US
Practice Address - Phone:714-318-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical