Provider Demographics
NPI:1396966586
Name:LEE, JUNE YOOSUNG (LAC)
Entity type:Individual
Prefix:DR
First Name:JUNE
Middle Name:YOOSUNG
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 1:401 ROLAND WAY STE 225
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2027
Mailing Address - Country:US
Mailing Address - Phone:510-444-1010
Mailing Address - Fax:510-383-9252
Practice Address - Street 1:401 ROLAND WAY STE 225
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2027
Practice Address - Country:US
Practice Address - Phone:510-444-1010
Practice Address - Fax:510-383-9252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC0066360171100000X
CAAC6636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9243033Medicaid