MEDICARE: DR. SE YONG LEE PH.D, L.AC.

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	19295	CA

General Provider Information

NPI Number	:	1902558430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SE YONG LEE PH.D, L.AC.

Provider Business Mailing Address
First Line	:	2120 W 8TH ST STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4081
Country	:	US
Telephone Number	:	213-386-4517
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 W 8TH ST STE 208
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4081
Country	:	US
Telephone Number	:	213-386-4517
Fax Number	:

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

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	01/25/2022

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