Provider Demographics
NPI:1750882577
Name:LEE, KYUNGHEE
Entity type:Individual
Prefix:
First Name:KYUNGHEE
Middle Name:
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 1:14785 JEFFREY RD STE 209
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0420
Mailing Address - Country:US
Mailing Address - Phone:949-653-5840
Mailing Address - Fax:
Practice Address - Street 1:14785 JEFFREY RD STE 209
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0420
Practice Address - Country:US
Practice Address - Phone:949-653-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12148171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty