Provider Demographics
NPI:1265712335
Name:LEE, HYUN KU (ACUPUNCTURE)
Entity type:Individual
Prefix:
First Name:HYUN
Middle Name:KU
Last Name:LEE
Suffix:
Gender:M
Credentials:ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 VIBORG RD
Mailing Address - Street 2:107
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93463-3219
Mailing Address - Country:US
Mailing Address - Phone:805-693-5162
Mailing Address - Fax:
Practice Address - Street 1:2030 VIBORG RD
Practice Address - Street 2:107
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-3219
Practice Address - Country:US
Practice Address - Phone:805-693-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist