Provider Demographics
NPI:1811674849
Name:DR. KWANG LEE WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:DR. KWANG LEE WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KWANG
Authorized Official - Middle Name:YUP
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:213-446-5935
Mailing Address - Street 1:440 SHATTO PL # 201-A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1793
Mailing Address - Country:US
Mailing Address - Phone:213-446-5935
Mailing Address - Fax:
Practice Address - Street 1:440 SHATTO PL # 201-A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1793
Practice Address - Country:US
Practice Address - Phone:213-446-5935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC28510OtherCHIROPRACTOR
CAAC6428OtherACUPUNCTURIST