Provider Demographics
NPI:1760269252
Name:LEE, SUJIN
Entity Type:Individual
Prefix:
First Name:SUJIN
Middle Name:
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 1:7151 LINCOLN AVE STE K
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4615
Mailing Address - Country:US
Mailing Address - Phone:714-952-1080
Mailing Address - Fax:714-952-1660
Practice Address - Street 1:7151 LINCOLN AVE STE K
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4615
Practice Address - Country:US
Practice Address - Phone:714-952-1080
Practice Address - Fax:714-952-1660
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19866171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist