Healthcare Provider Details

I. General information

NPI: 1265772560
Provider Name (Legal Business Name): JAY JUNGHOON LEE PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 W CARSON ST STE 106
TORRANCE CA
90501-3893
US

IV. Provider business mailing address

1613 W CARSON ST STE 106
TORRANCE CA
90501-3893
US

V. Phone/Fax

Practice location:
  • Phone: 213-268-7838
  • Fax: 213-823-1278
Mailing address:
  • Phone: 213-268-7838
  • Fax: 213-823-1278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: