Provider Demographics
NPI:1184750085
Name:LEE, SANGWON
Entity type:Individual
Prefix:DR
First Name:SANGWON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SANGWON
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC PHD
Mailing Address - Street 1:11419 MOORPARK ST
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2009
Mailing Address - Country:US
Mailing Address - Phone:818-762-1068
Mailing Address - Fax:818-762-1003
Practice Address - Street 1:11419 MOORPARK ST
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-2009
Practice Address - Country:US
Practice Address - Phone:818-762-1068
Practice Address - Fax:818-762-1003
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist