Provider Demographics
NPI:1538333026
Name:LEE, YONG HWI (LAC)
Entity Type:Individual
Prefix:
First Name:YONG HWI
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 1:315 N LOUISE ST
Mailing Address - Street 2:#204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-3566
Mailing Address - Country:US
Mailing Address - Phone:213-210-4923
Mailing Address - Fax:
Practice Address - Street 1:315 N LOUISE ST UNIT 204
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3528
Practice Address - Country:US
Practice Address - Phone:818-241-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11105171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11105OtherLICENCED ACUPUNCTURIST