Provider Demographics
NPI:1750752630
Name:LEE, SANG HYUN (LAC)
Entity type:Individual
Prefix:
First Name:SANG HYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:SANGHYUN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2595 E WASHINGTON BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1409
Mailing Address - Country:US
Mailing Address - Phone:266-393-8876
Mailing Address - Fax:626-639-3887
Practice Address - Street 1:2595 E WASHINGTON BLVD STE 108
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1409
Practice Address - Country:US
Practice Address - Phone:626-639-3887
Practice Address - Fax:626-639-3887
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16795171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist