Provider Demographics
NPI:1831680446
Name:LEE, ANDREW JAEJUN (MSTCM, DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAEJUN
Last Name:LEE
Suffix:
Gender:M
Credentials:MSTCM, DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 PARK CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94803-1226
Mailing Address - Country:US
Mailing Address - Phone:510-520-0798
Mailing Address - Fax:
Practice Address - Street 1:3980 SAN PABLO DAM RD STE 205
Practice Address - Street 2:
Practice Address - City:EL SOBRANTE
Practice Address - State:CA
Practice Address - Zip Code:94803
Practice Address - Country:US
Practice Address - Phone:510-730-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18116171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist