MEDICARE: SANG HEON LEE LAC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	171100000X	Acupuncturist	16836	CA

General Provider Information

NPI Number	:	1134641509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANG HEON LEE LAC.

Provider Business Mailing Address
First Line	:	12627 SANTA GERTRUDES AVE STE G
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-2533
Country	:	US
Telephone Number	:	714-337-8079
Fax Number	:

Provider Business Practice Location Address
First Line	:	12627 SANTA GERTRUDES AVE STE G
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-2533
Country	:	US
Telephone Number	:	714-337-8079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	02/27/2024

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Directions to “ SANG HEON LEE LAC.” Practice Location

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