Provider Demographics
NPI:1609046051
Name:LEE, MI-JUNG (ND,LAC)
Entity Type:Individual
Prefix:DR
First Name:MI-JUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:ND,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11406 102ND CT NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4318
Mailing Address - Country:US
Mailing Address - Phone:206-681-8713
Mailing Address - Fax:206-880-7158
Practice Address - Street 1:250 MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4811
Practice Address - Country:US
Practice Address - Phone:425-298-3801
Practice Address - Fax:206-880-7158
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60238093171100000X, 171100000X
WANT00001369175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA843647815Medicaid