Provider Demographics
NPI:1245337872
Name:LEE, ERIC GIM (DC, NP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:GIM
Last Name:LEE
Suffix:
Gender:M
Credentials:DC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W CAPITOL DR UNIT 38
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-2269
Mailing Address - Country:US
Mailing Address - Phone:310-325-7246
Mailing Address - Fax:
Practice Address - Street 1:6506 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-1330
Practice Address - Country:US
Practice Address - Phone:424-339-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25160111N00000X
CA95020519363LF0000X
CANP95020519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor