Provider Demographics
NPI:1083002901
Name:LEE, SU-JUNG (MSTOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:SU-JUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 GROVE ST # 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5334
Mailing Address - Country:US
Mailing Address - Phone:347-416-1464
Mailing Address - Fax:
Practice Address - Street 1:50 GREENE ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2663
Practice Address - Country:US
Practice Address - Phone:347-471-1585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist