Provider Demographics
NPI:1235680141
Name:LEE, JUNG A
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:A
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 MONTEVISTA DR SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8270
Mailing Address - Country:US
Mailing Address - Phone:253-269-2812
Mailing Address - Fax:
Practice Address - Street 1:124 4TH AVE S
Practice Address - Street 2:# 250
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5874
Practice Address - Country:US
Practice Address - Phone:253-854-5500
Practice Address - Fax:253-854-4098
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60689999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist