Provider Demographics
NPI:1700309192
Name:LEE, CHAN YOUNG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:CHAN YOUNG
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 1:18020 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5112
Mailing Address - Country:US
Mailing Address - Phone:424-329-3009
Mailing Address - Fax:424-329-3009
Practice Address - Street 1:18020 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5112
Practice Address - Country:US
Practice Address - Phone:424-329-3009
Practice Address - Fax:424-329-3009
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16611171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist