Provider Demographics
NPI:1508448341
Name:LEE, YOUNG HO
Entity Type:Individual
Prefix:
First Name:YOUNG HO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PASEO CAMARILLO
Mailing Address - Street 2:APT 208
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5992
Mailing Address - Country:US
Mailing Address - Phone:818-267-4156
Mailing Address - Fax:
Practice Address - Street 1:440 PASEO CAMARILLO APT 208
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5992
Practice Address - Country:US
Practice Address - Phone:818-267-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18277171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist