Provider Demographics
NPI:1548078413
Name:LEE, KYUNGHYE KIM
Entity type:Individual
Prefix:
First Name:KYUNGHYE
Middle Name:KIM
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S ARDMORE AVE UNIT 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1492
Mailing Address - Country:US
Mailing Address - Phone:213-628-6127
Mailing Address - Fax:
Practice Address - Street 1:908 S ARDMORE AVE UNIT 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1492
Practice Address - Country:US
Practice Address - Phone:213-628-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-24
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20243171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist