Provider Demographics
NPI:1790980811
Name:LEE, JAE H (DC, LAC)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 MONTE VIS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2013
Mailing Address - Country:US
Mailing Address - Phone:714-334-9965
Mailing Address - Fax:866-526-5046
Practice Address - Street 1:623 MONTE VIS
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2013
Practice Address - Country:US
Practice Address - Phone:714-334-9965
Practice Address - Fax:866-526-5046
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21036111N00000X
CAAC 5203171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist