Provider Demographics
NPI:1457573602
Name:LEE, YONG-TAE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:YONG-TAE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 DAGGET ST
Mailing Address - Street 2:102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2234
Mailing Address - Country:US
Mailing Address - Phone:858-569-4588
Mailing Address - Fax:858-569-4188
Practice Address - Street 1:7750 DAGGET ST
Practice Address - Street 2:102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2234
Practice Address - Country:US
Practice Address - Phone:858-569-4588
Practice Address - Fax:858-569-4188
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7424171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist