Provider Demographics
NPI:1174662944
Name:LEE, JOEY TZUNG (OMD)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:TZUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 TIMBERWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-0287
Mailing Address - Country:US
Mailing Address - Phone:949-302-3870
Mailing Address - Fax:949-502-5371
Practice Address - Street 1:15435 JEFFREY RD
Practice Address - Street 2:#109
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4104
Practice Address - Country:US
Practice Address - Phone:949-502-5370
Practice Address - Fax:949-502-5371
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist