Provider Demographics
NPI:1821321241
Name:LEE, JUNG SOON (PHD)
Entity Type:Individual
Prefix:
First Name:JUNG SOON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 W OLYMPIC BLVD
Mailing Address - Street 2:# 207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-6501
Mailing Address - Country:US
Mailing Address - Phone:213-738-7770
Mailing Address - Fax:213-738-7707
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:# 207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-738-7770
Practice Address - Fax:213-738-7707
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist