Provider Demographics
NPI:1578889002
Name:LEE, EUN HEA (LAC)
Entity Type:Individual
Prefix:
First Name:EUN
Middle Name:HEA
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12152 MONUMENT DR UNIT 380
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5508
Mailing Address - Country:US
Mailing Address - Phone:703-853-7175
Mailing Address - Fax:
Practice Address - Street 1:12152 MONUMENT DR UNIT 380
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5508
Practice Address - Country:US
Practice Address - Phone:703-853-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000535171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist