Provider Demographics
NPI:1497298368
Name:LEE, SU-CHEN (DAOM)
Entity Type:Individual
Prefix:DR
First Name:SU-CHEN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 CLARK LN
Mailing Address - Street 2:UNIT A
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4103
Mailing Address - Country:US
Mailing Address - Phone:310-422-8945
Mailing Address - Fax:
Practice Address - Street 1:1817 CLARK LN
Practice Address - Street 2:UNIT A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4103
Practice Address - Country:US
Practice Address - Phone:310-422-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 16228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist