Provider Demographics
NPI:1750193090
Name:LEE, SEUNGHOON PAUL (LAC)
Entity type:Individual
Prefix:
First Name:SEUNGHOON
Middle Name:PAUL
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:411 NW FLANDERS ST APT 609
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3856
Mailing Address - Country:US
Mailing Address - Phone:571-245-0694
Mailing Address - Fax:
Practice Address - Street 1:12778 SE STARK ST BLDG B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1539
Practice Address - Country:US
Practice Address - Phone:503-317-3113
Practice Address - Fax:503-459-4709
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC213507171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist