Provider Demographics
NPI:1215349873
Name:LEE, JINHUR (LAC)
Entity type:Individual
Prefix:
First Name:JINHUR
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:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-0546
Mailing Address - Country:US
Mailing Address - Phone:885-436-7600
Mailing Address - Fax:760-797-1845
Practice Address - Street 1:1625 W OLYMPIC BLVD STE M103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3824
Practice Address - Country:US
Practice Address - Phone:323-375-5147
Practice Address - Fax:323-523-3747
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10299171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist