Provider Demographics
NPI:1730362310
Name:LEE, MYUNGJAE (LAC)
Entity type:Individual
Prefix:
First Name:MYUNGJAE
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38431 5TH ST W
Mailing Address - Street 2:#H-142
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4277
Mailing Address - Country:US
Mailing Address - Phone:213-500-0532
Mailing Address - Fax:
Practice Address - Street 1:2045 ROYAL AVE
Practice Address - Street 2:#101
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4665
Practice Address - Country:US
Practice Address - Phone:805-527-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11994171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist