Provider Demographics
NPI:1649600172
Name:LEE, HYO SOO (R PH LAC)
Entity Type:Individual
Prefix:
First Name:HYO SOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:R PH LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 SANTA ROSALIA DR
Mailing Address - Street 2:3750 SANTA ROSALIA DR #1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3606
Mailing Address - Country:US
Mailing Address - Phone:323-295-5585
Mailing Address - Fax:323-293-7789
Practice Address - Street 1:3756 SANTA ROSALIA DR
Practice Address - Street 2:3750 SANTA ROSALIA DR #1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3606
Practice Address - Country:US
Practice Address - Phone:323-295-5585
Practice Address - Fax:323-293-7789
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42575183500000X
CA3856171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No171100000XOther Service ProvidersAcupuncturist