Provider Demographics
NPI:1376016949
Name:LEE, SANGWOOK (DC)
Entity Type:Individual
Prefix:DR
First Name:SANGWOOK
Middle Name:
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 1:20061 SATICOY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2692
Mailing Address - Country:US
Mailing Address - Phone:747-206-5288
Mailing Address - Fax:
Practice Address - Street 1:20061 SATICOY ST STE 101
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2692
Practice Address - Country:US
Practice Address - Phone:747-206-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18952171100000X
CA34384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor