Provider Demographics
NPI:1417297581
Name:LEE, KWENWOO (LAC)
Entity Type:Individual
Prefix:
First Name:KWENWOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 DEVONSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1338
Mailing Address - Country:US
Mailing Address - Phone:718-551-7199
Mailing Address - Fax:718-629-0693
Practice Address - Street 1:8923 AVENUE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1206
Practice Address - Country:US
Practice Address - Phone:718-629-4020
Practice Address - Fax:718-629-0693
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002537171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist