Provider Demographics
NPI:1720564032
Name:LEE, YOUNG HOON (DPT)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:HOON
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 PERALTA ST.
Mailing Address - Street 2:APT 7
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-8249
Mailing Address - Country:US
Mailing Address - Phone:702-985-9021
Mailing Address - Fax:
Practice Address - Street 1:3300 WEBSTER ST STE 1201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3126
Practice Address - Country:US
Practice Address - Phone:510-849-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist