Healthcare Provider Details

I. General information

NPI: 1326437252
Provider Name (Legal Business Name): ANDY JOO LEE D.C., L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13732 NEWPORT AVE STE 1
TUSTIN CA
92780-4698
US

IV. Provider business mailing address

13732 NEWPORT AVE STE 1
TUSTIN CA
92780-4698
US

V. Phone/Fax

Practice location:
  • Phone: 714-884-3955
  • Fax:
Mailing address:
  • Phone: 714-884-3955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32594
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: