1477851368 NPI number — MS. HAE WON LEE LA C

Table of content: MS. HAE WON LEE LA C (NPI 1477851368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477851368 NPI number — MS. HAE WON LEE LA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
HAE WON
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LA C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477851368
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 W 169TH ST APT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90247-5451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-756-4788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4055 WILSHIRE BLVD STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90010-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-756-4788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2011

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:  AC12205 , 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)

  • Identifier: AC12205 . This is a "LICENSED ACUPUNCTURIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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