Provider Demographics
NPI:1538590732
Name:LEE, SHARON YOUNG SOOK
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:YOUNG SOOK
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YEUNG
Other - Middle Name:SOOK
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40640 CHAMPION WAY
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:818-294-8905
Mailing Address - Fax:
Practice Address - Street 1:3010 PARAISO WAY
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1938
Practice Address - Country:US
Practice Address - Phone:818-294-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15506171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist