Provider Demographics
NPI:1134641509
Name:LEE, SANG HEON (LAC)
Entity Type:Individual
Prefix:
First Name:SANG HEON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12627 SANTA GERTRUDES AVE STE G
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-2533
Mailing Address - Country:US
Mailing Address - Phone:714-337-8079
Mailing Address - Fax:
Practice Address - Street 1:12627 SANTA GERTRUDES AVE STE G
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2533
Practice Address - Country:US
Practice Address - Phone:714-337-8079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CA16836171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty