Provider Demographics
NPI:1447608070
Name:LEE, JOOMAN
Entity Type:Individual
Prefix:
First Name:JOOMAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BIRCH AVE.
Mailing Address - Street 2:B
Mailing Address - City:RED WOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-610-6606
Mailing Address - Fax:650-362-1850
Practice Address - Street 1:77 BIRCH ST
Practice Address - Street 2:B
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1423
Practice Address - Country:US
Practice Address - Phone:510-610-6606
Practice Address - Fax:650-362-1850
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist