Provider Demographics
NPI:1194122929
Name:LEE, IN OK (LAC)
Entity type:Individual
Prefix:
First Name:IN OK
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N CATALINA ST
Mailing Address - Street 2:#1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-4740
Mailing Address - Country:US
Mailing Address - Phone:213-342-7982
Mailing Address - Fax:
Practice Address - Street 1:216 N CATALINA ST
Practice Address - Street 2:#1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-4740
Practice Address - Country:US
Practice Address - Phone:213-342-7982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16302171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA16302OtherL.AC