Provider Demographics
NPI:1275744054
Name:LEE, JOO BANG (LAC,OMD,PHD)
Entity Type:Individual
Prefix:DR
First Name:JOO
Middle Name:BANG
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC,OMD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13762 NEWPORT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4681
Mailing Address - Country:US
Mailing Address - Phone:714-838-6789
Mailing Address - Fax:
Practice Address - Street 1:13762 NEWPORT AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4681
Practice Address - Country:US
Practice Address - Phone:714-838-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC393171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist