Healthcare Provider Details

I. General information

NPI: 1932392321
Provider Name (Legal Business Name): IN SOO LEE ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 WARNER AVE #201
FOUNTAIN VALLEY CA
92708-3232
US

IV. Provider business mailing address

9755 BIXBY AVE #B
GARDEN GROVE CA
92841-3746
US

V. Phone/Fax

Practice location:
  • Phone: 714-398-5982
  • Fax: 714-848-3605
Mailing address:
  • Phone: 714-398-5982
  • Fax: 714-229-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: