Provider Demographics
NPI:1174822126
Name:LEE, SEA JIN (LAC)
Entity Type:Individual
Prefix:
First Name:SEA JIN
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 1:541 W.COLORADO ST #303
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3646
Mailing Address - Country:US
Mailing Address - Phone:818-545-7222
Mailing Address - Fax:818-545-9986
Practice Address - Street 1:541 W COLORADO ST STE 303
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3641
Practice Address - Country:US
Practice Address - Phone:818-545-7222
Practice Address - Fax:818-545-9986
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8674171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist