Provider Demographics
NPI:1881037851
Name:LEE, IRIS YESEUL (LAC)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:YESEUL
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 STANTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3678
Mailing Address - Country:US
Mailing Address - Phone:714-576-0890
Mailing Address - Fax:
Practice Address - Street 1:6881 STANTON AVE STE F
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3678
Practice Address - Country:US
Practice Address - Phone:714-576-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist