Provider Demographics
NPI:1669876744
Name:KIM LEE, HAEYUN
Entity type:Individual
Prefix:
First Name:HAEYUN
Middle Name:
Last Name:KIM LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12350 DEL AMO BLVD APT 313
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1704
Mailing Address - Country:US
Mailing Address - Phone:562-292-8422
Mailing Address - Fax:
Practice Address - Street 1:12350 DEL AMO BLVD APT 313
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1704
Practice Address - Country:US
Practice Address - Phone:562-292-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16306171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist