Provider Demographics
NPI:1609195825
Name:LEE, YOUNG SEO (LAC)
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:SEO
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9062 CHEVROLET DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-4018
Mailing Address - Country:US
Mailing Address - Phone:410-300-0693
Mailing Address - Fax:410-796-4377
Practice Address - Street 1:9062 CHEVROLET DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-4018
Practice Address - Country:US
Practice Address - Phone:410-300-0693
Practice Address - Fax:410-796-4377
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist