Provider Demographics
NPI:1396818217
Name:LEE, PAULINE MISUN (LAC)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:MISUN
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 1:23861 MCBEAN PKWY STE A3
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2085
Mailing Address - Country:US
Mailing Address - Phone:661-253-9986
Mailing Address - Fax:661-253-9987
Practice Address - Street 1:23861 MCBEAN PKWY STE A3
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2085
Practice Address - Country:US
Practice Address - Phone:661-253-9986
Practice Address - Fax:661-253-9987
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8806171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist