Provider Demographics
NPI:1306021019
Name:LEE, JONG HWA (LAC)
Entity Type:Individual
Prefix:DR
First Name:JONG HWA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:DR
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1300 QUAIL ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2711
Mailing Address - Country:US
Mailing Address - Phone:949-285-8253
Mailing Address - Fax:949-660-7087
Practice Address - Street 1:1300 QUAIL ST STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2711
Practice Address - Country:US
Practice Address - Phone:949-285-8253
Practice Address - Fax:949-660-7087
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist