Provider Demographics
NPI:1356609572
Name:LEE, TIMOTHY JUNG (LAC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:JUNGYUP
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5553 W. PICO BLVD.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019
Mailing Address - Country:US
Mailing Address - Phone:818-751-9392
Mailing Address - Fax:
Practice Address - Street 1:5553 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-3919
Practice Address - Country:US
Practice Address - Phone:818-751-9392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist