Provider Demographics
NPI:1417020256
Name:LEE, CHONG IN (AC)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:IN
Last Name:LEE
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:CHONG
Other - Middle Name:IN
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3537 TORRANCE BLVD
Mailing Address - Street 2:SUITE #24 25
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4818
Mailing Address - Country:US
Mailing Address - Phone:310-540-6724
Mailing Address - Fax:310-540-6719
Practice Address - Street 1:3537 TORRANCE BLVD
Practice Address - Street 2:SUITE #24 25
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4818
Practice Address - Country:US
Practice Address - Phone:310-540-6724
Practice Address - Fax:310-540-6719
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11108171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist