Provider Demographics
NPI:1306194279
Name:LEE, JAE HUN (LAC,OMD)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:HUN
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC,OMD
Other - Prefix:
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Mailing Address - Street 1:3142 ROCK PORT CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2738
Mailing Address - Country:US
Mailing Address - Phone:404-452-8424
Mailing Address - Fax:678-380-1100
Practice Address - Street 1:80 HORIZON DR STE 304B
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7740
Practice Address - Country:US
Practice Address - Phone:770-591-8797
Practice Address - Fax:770-209-3767
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13926171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171100000XOther Service ProvidersAcupuncturist