Provider Demographics
NPI:1740619006
Name:LEE, EUN JUNG
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:JUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13141 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1211
Mailing Address - Country:US
Mailing Address - Phone:714-590-3210
Mailing Address - Fax:714-591-5229
Practice Address - Street 1:13141 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1211
Practice Address - Country:US
Practice Address - Phone:714-590-3210
Practice Address - Fax:714-591-5229
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15719171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist