Provider Demographics
NPI:1184684417
Name:LEE, BRIAN SANGHWA (LAC, PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SANGHWA
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15785 LAGUNA CANYON RD STE 330
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3178
Mailing Address - Country:US
Mailing Address - Phone:949-424-6430
Mailing Address - Fax:949-612-0010
Practice Address - Street 1:15785 LAGUNA CANYON RD STE 330
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3178
Practice Address - Country:US
Practice Address - Phone:949-424-6430
Practice Address - Fax:949-612-0010
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8718171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9703241Medicaid