Healthcare Provider Details

I. General information

NPI: 1265854251
Provider Name (Legal Business Name): SUNGMIN YEE L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 10/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12706 BLOOMFIELD AVE, APT. 135
NORWALK CA
90650
US

IV. Provider business mailing address

421 N BROOKHURST ST #119
ANAHEIM CA
92801-5637
US

V. Phone/Fax

Practice location:
  • Phone: 818-279-4401
  • Fax:
Mailing address:
  • Phone: 818-279-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number15661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: