Provider Demographics
NPI:1134585557
Name:LEE, JI SOOK
Entity type:Individual
Prefix:
First Name:JI SOOK
Middle Name:
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 1:24248 CRENSHAW BLVD # 106
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5340
Mailing Address - Country:US
Mailing Address - Phone:310-906-5522
Mailing Address - Fax:310-961-5914
Practice Address - Street 1:24248 CRENSHAW BLVD # 106
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5340
Practice Address - Country:US
Practice Address - Phone:310-906-5522
Practice Address - Fax:310-961-5914
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7113171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist