Provider Demographics
NPI:1922382316
Name:LEE, HONG JOON (LAC, MS)
Entity type:Individual
Prefix:MR
First Name:HONG JOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1109 KENNEDY PL STE 5
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1271
Mailing Address - Country:US
Mailing Address - Phone:530-756-1445
Mailing Address - Fax:530-756-1450
Practice Address - Street 1:1109 KENNEDY PL STE 5
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1271
Practice Address - Country:US
Practice Address - Phone:530-756-1445
Practice Address - Fax:530-756-1450
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14392171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist