Provider Demographics
NPI:1437364858
Name:LEE, SUMI FONG (PHD LAC)
Entity Type:Individual
Prefix:DR
First Name:SUMI
Middle Name:FONG
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 W KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1605
Mailing Address - Country:US
Mailing Address - Phone:813-251-3089
Mailing Address - Fax:813-251-5668
Practice Address - Street 1:1804 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1605
Practice Address - Country:US
Practice Address - Phone:813-251-3089
Practice Address - Fax:813-251-5668
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist