Provider Demographics
NPI:1770867475
Name:LEE, HEE EUN (LAC)
Entity Type:Individual
Prefix:
First Name:HEE EUN
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 1:3967 FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1621
Mailing Address - Country:US
Mailing Address - Phone:818-495-5252
Mailing Address - Fax:
Practice Address - Street 1:3967 FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1621
Practice Address - Country:US
Practice Address - Phone:818-495-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14421171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist