Provider Demographics
NPI:1811162589
Name:LEE, KYUNG H (LAC)
Entity type:Individual
Prefix:
First Name:KYUNG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18031 US HIGHWAY 18
Mailing Address - Street 2:SUITE #D
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2152
Mailing Address - Country:US
Mailing Address - Phone:760-242-3255
Mailing Address - Fax:760-242-3552
Practice Address - Street 1:18031 US HIGHWAY 18
Practice Address - Street 2:SUITE #D
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2152
Practice Address - Country:US
Practice Address - Phone:760-242-3255
Practice Address - Fax:760-242-3552
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist