Provider Demographics
NPI:1740837384
Name:LEE, ANNIE SOMI
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:SOMI
Last Name: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 1:1458 S SAN PEDRO ST # L19
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3144
Mailing Address - Country:US
Mailing Address - Phone:213-536-5349
Mailing Address - Fax:213-289-2631
Practice Address - Street 1:1458 S SAN PEDRO ST # L19
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3144
Practice Address - Country:US
Practice Address - Phone:213-536-5349
Practice Address - Fax:213-289-2631
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC34571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor