Provider Demographics
NPI:1376758276
Name:LEE, YONG H (OMD)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S ALAMEDA ST STE 213
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1734
Mailing Address - Country:US
Mailing Address - Phone:213-626-7017
Mailing Address - Fax:213-626-7018
Practice Address - Street 1:333 S ALAMEDA ST STE 213
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1734
Practice Address - Country:US
Practice Address - Phone:213-626-7017
Practice Address - Fax:213-626-7018
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10886171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist