Provider Demographics
NPI:1376928242
Name:LEE, HYO JOON (LAC)
Entity Type:Individual
Prefix:
First Name:HYO
Middle Name:JOON
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S PROSPECTORS RD
Mailing Address - Street 2:#H
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1615
Mailing Address - Country:US
Mailing Address - Phone:626-733-7636
Mailing Address - Fax:
Practice Address - Street 1:414 S PROSPECTORS RD
Practice Address - Street 2:#H
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1615
Practice Address - Country:US
Practice Address - Phone:626-733-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist