Provider Demographics
NPI:1750159182
Name:LEE, TAE JOON
Entity type:Individual
Prefix:
First Name:TAE JOON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30250 GUNTHER RD
Mailing Address - Street 2:
Mailing Address - City:ROMOLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9758
Mailing Address - Country:US
Mailing Address - Phone:213-369-0396
Mailing Address - Fax:
Practice Address - Street 1:30250 GUNTHER RD
Practice Address - Street 2:
Practice Address - City:ROMOLAND
Practice Address - State:CA
Practice Address - Zip Code:92585-9758
Practice Address - Country:US
Practice Address - Phone:213-369-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist