Healthcare Provider Details

I. General information

NPI: 1053295519
Provider Name (Legal Business Name): JINWON LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14575 NE BEL RED RD STE 100
BELLEVUE WA
98007-3908
US

IV. Provider business mailing address

14575 NE BEL RED RD STE 100
BELLEVUE WA
98007-3908
US

V. Phone/Fax

Practice location:
  • Phone: 425-818-0979
  • Fax:
Mailing address:
  • Phone: 949-302-3841
  • Fax: 425-818-5096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUP.AC.70037660
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: