Provider Demographics
NPI:1871968883
Name:LEE, SEUNGYEOP
Entity type:Individual
Prefix:
First Name:SEUNGYEOP
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 MADISON ST
Mailing Address - Street 2:APT 215
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-4553
Mailing Address - Country:US
Mailing Address - Phone:510-277-2925
Mailing Address - Fax:
Practice Address - Street 1:2090 WARM SPRINGS CT
Practice Address - Street 2:#108
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-6759
Practice Address - Country:US
Practice Address - Phone:510-619-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16646171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist