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General NPI Number Information
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NPI Number | 1417112376
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Entity Type | Individual
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Provider Name | SEUNGYONG LEE LAC
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Gender | Male
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 3030 W OLYMPIC BLVD STE 210
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City | LOS ANGELES
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State | CA
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Zip | 90006-6509
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Country | US
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Telephone | 213-365-1758
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 W OLYMPIC BLVD STE 210
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City | LOS ANGELES
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State | CA
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Zip | 90006-6509
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Country | US
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Telephone | 213-248-7017
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 11995
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License Number State | CA
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