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General NPI Number Information
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NPI Number | 1962631119
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Entity Type | Individual
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Provider Name | YOUNGNAM LEE L.AC.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2009
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 1080 S LA CIENEGA BLVD STE 201
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City | LOS ANGELES
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State | CA
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Zip | 90035-2679
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Country | US
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Telephone | 310-984-1555
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Fax | 310-358-0426
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Provider Business Mailing Address
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Address Line | 400 S BURNSIDE AVE APT 4C
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City | LOS ANGELES
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State | CA
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Zip | 90036-5478
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Country | US
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Telephone | 213-820-0994
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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 | AC13034
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License Number State | CA
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