Provider Demographics
NPI:1669778817
Name:LEE, WON JU (LAC)
Entity type:Individual
Prefix:MISS
First Name:WON
Middle Name:JU
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:19119 NORDHOFF ST
Mailing Address - Street 2:424
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-3686
Mailing Address - Country:US
Mailing Address - Phone:818-912-9998
Mailing Address - Fax:
Practice Address - Street 1:26767 AGOURA RD.
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-878-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist