Healthcare Provider Details

I. General information

NPI: 1336359942
Provider Name (Legal Business Name): JAY JAE-YOUNG LEE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8157 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-4912
US

IV. Provider business mailing address

8157 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-4912
US

V. Phone/Fax

Practice location:
  • Phone: 323-848-8036
  • Fax: 323-848-8294
Mailing address:
  • Phone: 323-848-8036
  • Fax: 323-848-8294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: