Provider Demographics
NPI:1679235436
Name:LEE & KIM ACUPUNCTURE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LEE & KIM ACUPUNCTURE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:WOO JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, DIPL OM
Authorized Official - Phone:213-219-2696
Mailing Address - Street 1:9090 MOODY ST APT 111
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-2940
Mailing Address - Country:US
Mailing Address - Phone:657-341-2125
Mailing Address - Fax:
Practice Address - Street 1:9090 MOODY ST APT 111
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-2940
Practice Address - Country:US
Practice Address - Phone:657-341-2125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245773027Medicaid
CA1598051286Medicaid