Provider Demographics
NPI:1790006211
Name:LEE, JOO H (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOO
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 WILSHIRE BLVD.
Mailing Address - Street 2:# 202 (LIVIWELL)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010
Mailing Address - Country:US
Mailing Address - Phone:323-936-5484
Mailing Address - Fax:323-954-9355
Practice Address - Street 1:4465 WILSHIRE BLVD
Practice Address - Street 2:# 202 (LIVIWELL)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3704
Practice Address - Country:US
Practice Address - Phone:323-936-5484
Practice Address - Fax:323-954-9355
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12917171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist