Provider Demographics
NPI:1639297153
Name:LEE, GLORIA EUNSOOK (ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:EUNSOOK
Last Name:LEE
Suffix:
Gender:F
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S VIRGIL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1425
Mailing Address - Country:US
Mailing Address - Phone:213-389-8275
Mailing Address - Fax:213-736-5189
Practice Address - Street 1:520 S VIRGIL AVE STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1425
Practice Address - Country:US
Practice Address - Phone:213-389-8275
Practice Address - Fax:213-736-5189
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist