Provider Demographics
NPI:1902558430
Name:LEE, SE YONG (PHD, LAC)
Entity Type:Individual
Prefix:DR
First Name:SE YONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W 8TH ST STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4081
Mailing Address - Country:US
Mailing Address - Phone:213-386-4517
Mailing Address - Fax:
Practice Address - Street 1:2120 W 8TH ST STE 208
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4081
Practice Address - Country:US
Practice Address - Phone:213-386-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19295171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist