Provider Demographics
NPI:1528402690
Name:LEE, SEUNG GON
Entity Type:Individual
Prefix:DR
First Name:SEUNG GON
Middle Name:
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 1:1005 MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5539
Mailing Address - Country:US
Mailing Address - Phone:267-772-4579
Mailing Address - Fax:
Practice Address - Street 1:1005 MOUNTAINVIEW DR
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-5539
Practice Address - Country:US
Practice Address - Phone:267-772-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist