Healthcare Provider Details

I. General information

NPI: 1558868810
Provider Name (Legal Business Name): SEUNG WON LEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 545
BEAVERTON OR
97005-4739
US

IV. Provider business mailing address

14951 NW COSMOS ST
PORTLAND OR
97229-6975
US

V. Phone/Fax

Practice location:
  • Phone: 503-430-1380
  • Fax: 503-430-1758
Mailing address:
  • Phone: 503-430-1380
  • Fax: 503-430-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC220283
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5874
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: