Provider Demographics
NPI:1144393026
Name:LEE, YOUNG SUK (LAC)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:SUK
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 1:15346 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1122
Mailing Address - Country:US
Mailing Address - Phone:818-361-0997
Mailing Address - Fax:
Practice Address - Street 1:15346 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1122
Practice Address - Country:US
Practice Address - Phone:818-361-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5649171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist