Healthcare Provider Details

I. General information

NPI: 1801300975
Provider Name (Legal Business Name): LEE ACUPUNCTURE WELLNESS RECOVER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13141 CENTURY BLVD
GARDEN GROVE CA
92843-1211
US

IV. Provider business mailing address

13141 CENTURY BLVD
GARDEN GROVE CA
92843-1211
US

V. Phone/Fax

Practice location:
  • Phone: 714-590-3210
  • Fax: 714-591-5229
Mailing address:
  • Phone: 714-590-3210
  • Fax: 714-591-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15719
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAC15719
License Number StateCA

VIII. Authorized Official

Name: EUN JUNG LEE
Title or Position: OWNER
Credential:
Phone: 714-590-3210