Provider Demographics
NPI:1972824837
Name:LEE, MIRAN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:MIRAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:525 S LA FAYETTE PARK PL
Mailing Address - Street 2:315
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1662
Mailing Address - Country:US
Mailing Address - Phone:213-399-8575
Mailing Address - Fax:213-399-8575
Practice Address - Street 1:2716 S VERMONT AVE
Practice Address - Street 2:10
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2671
Practice Address - Country:US
Practice Address - Phone:213-399-8575
Practice Address - Fax:213-995-6363
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist