Provider Demographics
NPI:1871834929
Name:LEE, SUB (LAC)
Entity Type:Individual
Prefix:MR
First Name:SUB
Middle Name:
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 1:2260 W LINCOLN AVE
Mailing Address - Street 2:#M3
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-6550
Mailing Address - Country:US
Mailing Address - Phone:714-335-7089
Mailing Address - Fax:
Practice Address - Street 1:2260 W LINCOLN AVE
Practice Address - Street 2:#M3
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6550
Practice Address - Country:US
Practice Address - Phone:714-335-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist