Provider Demographics
NPI:1306139175
Name:LEE, HYOJOO SUSAN
Entity type:Individual
Prefix:
First Name:HYOJOO
Middle Name:SUSAN
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 1:739 S. LORRAINE BLVD
Mailing Address - Street 2:#A03
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005
Mailing Address - Country:US
Mailing Address - Phone:213-273-5827
Mailing Address - Fax:
Practice Address - Street 1:2727 W OLYMPIC BLVD
Practice Address - Street 2:#302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-382-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11412225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation