Provider Demographics
NPI:1427634252
Name:LEE, CHRISTINE HEUIJUNG
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HEUIJUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 BARRANCA PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-1703
Mailing Address - Country:US
Mailing Address - Phone:949-394-1432
Mailing Address - Fax:
Practice Address - Street 1:4330 BARRANCA PKWY STE 135
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-1703
Practice Address - Country:US
Practice Address - Phone:949-331-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18999171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist