Provider Demographics
NPI:1336359942
Name:LEE, JAY JAE-YOUNG (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:JAE-YOUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8157 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4912
Mailing Address - Country:US
Mailing Address - Phone:323-848-8036
Mailing Address - Fax:323-848-8294
Practice Address - Street 1:8157 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-4912
Practice Address - Country:US
Practice Address - Phone:323-848-8036
Practice Address - Fax:323-848-8294
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor