Provider Demographics
NPI:1588364632
Name:LEE, MINHYOUNG
Entity type:Individual
Prefix:
First Name:MINHYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 S BEACH BLVD STE 216
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-1184
Mailing Address - Country:US
Mailing Address - Phone:213-814-9377
Mailing Address - Fax:
Practice Address - Street 1:1201 S BEACH BLVD STE 216
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-1184
Practice Address - Country:US
Practice Address - Phone:213-565-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232754208246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD7700780OtherMEDICAL SUPPLIER