Provider Demographics
NPI:1083829691
Name:LEE, CLIFFORD SUK-JAE (LAC, DIPLOM)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:SUK-JAE
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9872 CHAPMAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-2733
Mailing Address - Country:US
Mailing Address - Phone:714-539-3902
Mailing Address - Fax:714-539-3902
Practice Address - Street 1:9872 CHAPMAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-2733
Practice Address - Country:US
Practice Address - Phone:714-539-3902
Practice Address - Fax:714-539-3902
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11744171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist