1306021019 NPI number — DR. JONG HWA LEE LAC

Table of content: DR. JONG HWA LEE LAC (NPI 1306021019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306021019 NPI number — DR. JONG HWA LEE LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
JONG HWA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
JASON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LA.C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306021019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 QUAIL ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-285-8253
Provider Business Mailing Address Fax Number:
949-660-7087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 QUAIL ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-285-8253
Provider Business Practice Location Address Fax Number:
949-660-7087
Provider Enumeration Date:
01/02/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC11979 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)