Provider Demographics
NPI:1235577438
Name:LEE, JONG HWA (PA LICACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:HWA
Last Name:LEE
Suffix:
Gender:M
Credentials:PA LICACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3310
Mailing Address - Country:US
Mailing Address - Phone:215-224-2070
Mailing Address - Fax:
Practice Address - Street 1:317 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3310
Practice Address - Country:US
Practice Address - Phone:215-224-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000193L171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist