Provider Demographics
NPI:1518138874
Name:LEE, JUNG SUK
Entity Type:Individual
Prefix:MR
First Name:JUNG
Middle Name:SUK
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BROOKES AVE
Mailing Address - Street 2:SUITE102
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2753
Mailing Address - Country:US
Mailing Address - Phone:301-880-9119
Mailing Address - Fax:
Practice Address - Street 1:8 BROOKES AVE
Practice Address - Street 2:SUITE102
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2753
Practice Address - Country:US
Practice Address - Phone:301-880-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01155171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist