Provider Demographics
NPI:1801417563
Name:LEE, SANGWOOK (DC)
Entity Type:Individual
Prefix:DR
First Name:SANGWOOK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:17411 IRVINE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3025
Mailing Address - Country:US
Mailing Address - Phone:916-260-6198
Mailing Address - Fax:
Practice Address - Street 1:680 S BERENDO ST APT 529
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2087
Practice Address - Country:US
Practice Address - Phone:916-260-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor