Provider Demographics
NPI:1861408726
Name:LEE, MOONYOUNG MILTON (DC)
Entity type:Individual
Prefix:DR
First Name:MOONYOUNG
Middle Name:MILTON
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5831 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2021
Mailing Address - Country:US
Mailing Address - Phone:714-994-1740
Mailing Address - Fax:714-994-1430
Practice Address - Street 1:5831 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2021
Practice Address - Country:US
Practice Address - Phone:714-994-1470
Practice Address - Fax:714-994-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25158111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC25158AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER