Provider Demographics
NPI:1114484219
Name:LEE, SUNG YOUN (LAC)
Entity Type:Individual
Prefix:
First Name:SUNG YOUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SHIRA LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8800
Mailing Address - Country:US
Mailing Address - Phone:732-740-4355
Mailing Address - Fax:732-872-1508
Practice Address - Street 1:2373 HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2560
Practice Address - Country:US
Practice Address - Phone:732-872-6595
Practice Address - Fax:732-872-1508
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00136000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1336349331OtherNPI