Healthcare Provider Details

I. General information

NPI: 1811674849
Provider Name (Legal Business Name): DR. KWANG LEE WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 08/05/2023
Certification Date: 08/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SHATTO PL # 201-A
LOS ANGELES CA
90020-1793
US

IV. Provider business mailing address

440 SHATTO PL # 201-A
LOS ANGELES CA
90020-1793
US

V. Phone/Fax

Practice location:
  • Phone: 213-446-5935
  • Fax:
Mailing address:
  • Phone: 213-446-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. KWANG YUP LEE
Title or Position: CEO
Credential: DC, LAC
Phone: 213-446-5935