Provider Demographics
NPI:1700476702
Name:LEE, EDWARD BYUNGDO (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:BYUNGDO
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 N STUDEBAKER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2458
Mailing Address - Country:US
Mailing Address - Phone:562-982-4208
Mailing Address - Fax:562-286-8344
Practice Address - Street 1:3960 N STUDEBAKER RD STE 102
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2458
Practice Address - Country:US
Practice Address - Phone:562-982-4208
Practice Address - Fax:562-286-8344
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty