Provider Demographics
NPI:1215380597
Name:LEE, SEUNGHUN (LAC)
Entity Type:Individual
Prefix:
First Name:SEUNGHUN
Middle Name:
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 1:19144 INDEX ST UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-1619
Mailing Address - Country:US
Mailing Address - Phone:213-434-1389
Mailing Address - Fax:
Practice Address - Street 1:3434 W 6TH ST STE 400-3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2526
Practice Address - Country:US
Practice Address - Phone:213-434-1389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14307171100000X
CAAC 14307171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist