Provider Demographics
NPI:1265772560
Name:LEE, JUNGHOON (PHD)
Entity type:Individual
Prefix:
First Name:JUNGHOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#B1
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2942
Mailing Address - Country:US
Mailing Address - Phone:213-268-7838
Mailing Address - Fax:
Practice Address - Street 1:2125 E THOUSAND OAKS BOULEVARD
Practice Address - Street 2:B1
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2904
Practice Address - Country:US
Practice Address - Phone:213-268-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13859171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171100000XOtherACUPUNCTURIST