Provider Demographics
NPI:1407220171
Name:LEE, SUN RYE (LAC, PHD)
Entity Type:Individual
Prefix:MRS
First Name:SUN
Middle Name:RYE
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 W 6TH ST
Mailing Address - Street 2:#308
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020
Mailing Address - Country:US
Mailing Address - Phone:213-380-6868
Mailing Address - Fax:
Practice Address - Street 1:3663 W 6TH ST
Practice Address - Street 2:#308
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020
Practice Address - Country:US
Practice Address - Phone:213-380-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4133171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist