Provider Demographics
NPI:1093857310
Name:LEE, HAE OK (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HAE
Middle Name:OK
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:16206 S. WESTERN AVE
Mailing Address - Street 2:#G
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247
Mailing Address - Country:US
Mailing Address - Phone:310-324-1790
Mailing Address - Fax:310-324-1727
Practice Address - Street 1:16206 S. WESTERN AVE
Practice Address - Street 2:#G
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-324-1790
Practice Address - Fax:310-324-1727
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC9286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8399636Medicaid