Provider Demographics
NPI:1568863363
Name:LEE, JUYOUNG
Entity Type:Individual
Prefix:
First Name:JUYOUNG
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 1:2501 FOOTHILL BLVD
Mailing Address - Street 2:APT 2
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3507
Mailing Address - Country:US
Mailing Address - Phone:818-521-7891
Mailing Address - Fax:818-236-3007
Practice Address - Street 1:2501 FOOTHILL BLVD
Practice Address - Street 2:APT 2
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3507
Practice Address - Country:US
Practice Address - Phone:818-521-7891
Practice Address - Fax:818-236-3007
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15082171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist