Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC 25589 | CA |
NPI | 1376853416 |
---|---|
Provider Name | Dr. Seok Joon Lee |
First Address | Los Angeles, CA 90010-2388 |
Second Address | Los Angeles, CA 90010-2388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2010 |
Last Update Date | 28/06/2011 |