Provider Demographics
NPI:1891905360
Name:LEE, KYUNG H
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 LENOX PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1394
Mailing Address - Country:US
Mailing Address - Phone:650-269-9488
Mailing Address - Fax:408-855-0989
Practice Address - Street 1:3970 RIVERMARK PLZ
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-4155
Practice Address - Country:US
Practice Address - Phone:408-855-0985
Practice Address - Fax:408-855-0989
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8315171100000X
CA40813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No183500000XPharmacy Service ProvidersPharmacist