Provider Demographics
NPI:1144420571
Name:LEE, SEUNG YONG (LAC)
Entity Type:Individual
Prefix:MR
First Name:SEUNG
Middle Name:YONG
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 1:3755 BEVERLY BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3539
Mailing Address - Country:US
Mailing Address - Phone:714-321-8972
Mailing Address - Fax:
Practice Address - Street 1:3755 BEVERLY BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3539
Practice Address - Country:US
Practice Address - Phone:714-321-8972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 11214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist