Provider Demographics
NPI:1851317879
Name:LEE, WEE EUN (DC)
Entity type:Individual
Prefix:
First Name:WEE
Middle Name:EUN
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 1:675 PAULARINO AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3039
Mailing Address - Country:US
Mailing Address - Phone:714-957-6642
Mailing Address - Fax:714-957-2987
Practice Address - Street 1:675 PAULARINO AVE STE 7
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3039
Practice Address - Country:US
Practice Address - Phone:714-957-6642
Practice Address - Fax:714-957-2987
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15288111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS625ZMedicare PIN