Provider Demographics
NPI:1275869471
Name:LEE, SANGGOO (LAC)
Entity Type:Individual
Prefix:MR
First Name:SANGGOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5510 CASCADE WAY
Mailing Address - Street 2:#A
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1755
Mailing Address - Country:US
Mailing Address - Phone:714-399-6936
Mailing Address - Fax:
Practice Address - Street 1:50 PENINSULA CTR STE D
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3563
Practice Address - Country:US
Practice Address - Phone:310-541-7999
Practice Address - Fax:310-544-1969
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12955171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist