Provider Demographics
NPI:1477851368
Name:LEE, HAE WON (LA C)
Entity type:Individual
Prefix:MS
First Name:HAE WON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 W 169TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5451
Mailing Address - Country:US
Mailing Address - Phone:213-756-4788
Mailing Address - Fax:
Practice Address - Street 1:4055 WILSHIRE BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3403
Practice Address - Country:US
Practice Address - Phone:213-756-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12205171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12205OtherLICENSED ACUPUNCTURIST