Provider Demographics
NPI:1215415849
Name:LEE, JUN BUM (LAC)
Entity Type:Individual
Prefix:
First Name:JUN BUM
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7331 E OSBORN DR STE 420
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6415
Mailing Address - Country:US
Mailing Address - Phone:480-372-4104
Mailing Address - Fax:480-372-4923
Practice Address - Street 1:7331 E OSBORN DR STE 420
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-372-4104
Practice Address - Fax:480-372-4923
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1137171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist