Provider Demographics
NPI:1487491650
Name:LEE, SEAN TAEHO (DC)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:TAEHO
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17125 S VERMONT AVE UNIT 12
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5869
Mailing Address - Country:US
Mailing Address - Phone:714-900-0695
Mailing Address - Fax:
Practice Address - Street 1:11121 LOS ALAMITOS BLVD STE 203
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3889
Practice Address - Country:US
Practice Address - Phone:714-230-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor