Provider Demographics
NPI:1932392321
Name:LEE, IN SOO (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:IN SOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9755 BIXBY AVE
Mailing Address - Street 2:#B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3746
Mailing Address - Country:US
Mailing Address - Phone:714-398-5982
Mailing Address - Fax:714-229-9682
Practice Address - Street 1:8840 WARNER AVE
Practice Address - Street 2:#201
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3232
Practice Address - Country:US
Practice Address - Phone:714-398-5982
Practice Address - Fax:714-848-3605
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9645171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist