Provider Demographics
NPI:1497058564
Name:LEE, MYEONGCHEOL (LAC)
Entity Type:Individual
Prefix:
First Name:MYEONGCHEOL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5934
Mailing Address - Country:US
Mailing Address - Phone:714-771-0700
Mailing Address - Fax:714-771-0700
Practice Address - Street 1:1516 E COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5934
Practice Address - Country:US
Practice Address - Phone:714-771-0700
Practice Address - Fax:714-771-0700
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist