Provider Demographics
NPI:1578860201
Name:LEE, MICHAEL YOUNG JOON (LAC, EAMP, MACOM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:YOUNG JOON
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, EAMP, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 NE 116TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-2401
Mailing Address - Country:US
Mailing Address - Phone:360-892-4355
Mailing Address - Fax:
Practice Address - Street 1:6405 NE 116TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-2401
Practice Address - Country:US
Practice Address - Phone:360-892-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60197003171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist