Healthcare Provider Details

I. General information

NPI: 1255889440
Provider Name (Legal Business Name): JU HYEON LEE L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 E GRAYSTONE WAY STE 7
SALT LAKE CITY UT
84106-2671
US

IV. Provider business mailing address

1734 E 2100 S
SALT LAKE CITY UT
84106-4142
US

V. Phone/Fax

Practice location:
  • Phone: 714-403-5994
  • Fax:
Mailing address:
  • Phone: 714-403-5994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14190328-1201
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: