=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700151115
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUNG GUN LEE ACUPUNCTURIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2012
-----------------------------------------------------
Last Update Date | 03/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 991 ARAPAHOE ST UNIT 406
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-5839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-270-5001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2960 WILSHIRE BLVD STE 320
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-270-5001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC12728
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------