Provider Demographics
NPI:1306257886
Name:LEE, SOON MIN (LAC)
Entity type:Individual
Prefix:MR
First Name:SOON
Middle Name:MIN
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:18102 IRVINE BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3424
Mailing Address - Country:US
Mailing Address - Phone:714-340-5133
Mailing Address - Fax:657-223-2246
Practice Address - Street 1:18102 IRVINE BLVD STE 209
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3424
Practice Address - Country:US
Practice Address - Phone:714-340-5133
Practice Address - Fax:657-223-2246
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-18
Last Update Date:2015-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA16107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist