Provider Demographics
NPI:1114157526
Name:LEE, HYOJUNG (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HYOJUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 ESTUDILLO AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4915
Mailing Address - Country:US
Mailing Address - Phone:510-357-6800
Mailing Address - Fax:510-357-6801
Practice Address - Street 1:433 ESTUDILLO AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:510-357-6800
Practice Address - Fax:510-357-6801
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12854171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist