Provider Demographics
NPI:1477963148
Name:LEE, JIN YOUNG (LAC)
Entity Type:Individual
Prefix:
First Name:JIN YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 BOWE AVE APT 611
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3834
Mailing Address - Country:US
Mailing Address - Phone:408-660-5921
Mailing Address - Fax:866-275-7594
Practice Address - Street 1:1288 KIFER RD STE 202
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5326
Practice Address - Country:US
Practice Address - Phone:408-831-3815
Practice Address - Fax:408-831-3816
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist