Provider Demographics
NPI:1609944958
Name:LEE, MIN HEE (AMD LAC)
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:HEE
Last Name:LEE
Suffix:
Gender:M
Credentials:AMD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-385-6688
Mailing Address - Fax:213-385-2362
Practice Address - Street 1:3000 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006
Practice Address - Country:US
Practice Address - Phone:213-385-6688
Practice Address - Fax:213-385-2362
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3184171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0031840Medicaid