Provider Demographics
NPI:1639622145
Name:LEE, YOUNG WOO
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:WOO
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 MOODY ST
Mailing Address - Street 2:SUITE# 111-A
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1180
Mailing Address - Country:US
Mailing Address - Phone:714-886-7432
Mailing Address - Fax:
Practice Address - Street 1:7002 MOODY ST
Practice Address - Street 2:SUITE# 111-A
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1180
Practice Address - Country:US
Practice Address - Phone:714-733-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist