Provider Demographics
NPI:1326437252
Name:LEE, ANDY JOO (DC)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:JOO
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18246 SOLANO RIVER CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5949
Mailing Address - Country:US
Mailing Address - Phone:714-968-4374
Mailing Address - Fax:
Practice Address - Street 1:18246 SOLANO RIVER CT
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5949
Practice Address - Country:US
Practice Address - Phone:714-968-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor