Provider Demographics
NPI:1760666218
Name:LEE, CHRISTINE JIEUN (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JIEUN
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JIEUN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:14151 NEWPORT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5163
Mailing Address - Country:US
Mailing Address - Phone:714-838-8931
Mailing Address - Fax:713-838-1114
Practice Address - Street 1:14151 NEWPORT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5163
Practice Address - Country:US
Practice Address - Phone:714-838-8931
Practice Address - Fax:713-838-1114
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist