Provider Demographics
NPI:1710026976
Name:LEE, IN SOOK (LAC)
Entity Type:Individual
Prefix:
First Name:IN SOOK
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S HARVARD BLVD APT 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2596
Mailing Address - Country:US
Mailing Address - Phone:213-926-6034
Mailing Address - Fax:818-400-8826
Practice Address - Street 1:2300 W VICTORY BLVD
Practice Address - Street 2:E
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-1256
Practice Address - Country:US
Practice Address - Phone:213-926-6034
Practice Address - Fax:818-400-8826
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7030171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC7030OtherLICENSED ACUPUNCTURIST