Provider Demographics
NPI:1932500345
Name:LEE, TAE HYUN
Entity Type:Individual
Prefix:DR
First Name:TAE
Middle Name:HYUN
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 EL CAMINO REAL # 9
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2803
Mailing Address - Country:US
Mailing Address - Phone:408-261-9711
Mailing Address - Fax:408-261-0141
Practice Address - Street 1:3216 EL CAMINO REAL # 9
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2803
Practice Address - Country:US
Practice Address - Phone:408-261-9711
Practice Address - Fax:408-261-0141
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor