Provider Demographics
NPI:1265099675
Name:T.J. LEE, L.AC., INC.
Entity type:Organization
Organization Name:T.J. LEE, L.AC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:JUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:714-943-8511
Mailing Address - Street 1:2448 LAZY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5619
Mailing Address - Country:US
Mailing Address - Phone:714-943-8511
Mailing Address - Fax:
Practice Address - Street 1:16960 BASTANCHURY RD STE J
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1711
Practice Address - Country:US
Practice Address - Phone:714-943-8511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center