Provider Demographics
NPI:1275379224
Name:LEE, HAESHIN (BS)
Entity type:Individual
Prefix:MRS
First Name:HAESHIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3550 CAMINO DEL RIO N STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1738
Mailing Address - Country:US
Mailing Address - Phone:760-815-9536
Mailing Address - Fax:
Practice Address - Street 1:3550 CAMINO DEL RIO N STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1738
Practice Address - Country:US
Practice Address - Phone:760-815-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician