Provider Demographics
NPI:1700151115
Name:LEE, JUNG GUN (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:GUN
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 1:2960 WILSHIRE BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1154
Mailing Address - Country:US
Mailing Address - Phone:213-270-5001
Mailing Address - Fax:
Practice Address - Street 1:991 ARAPAHOE ST UNIT 406
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5839
Practice Address - Country:US
Practice Address - Phone:213-270-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12728171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist