Provider Demographics
NPI:1649413758
Name:LEE, CALEB DAEKYU (LAC,OMD, RN)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:DAEKYU
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC,OMD, RN
Other - Prefix:
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Mailing Address - Street 1:8005 HIGH CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-5517
Mailing Address - Country:US
Mailing Address - Phone:443-848-0279
Mailing Address - Fax:410-313-8157
Practice Address - Street 1:9380 BALTIMORE NATIONAL PIKE STE 109
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2826
Practice Address - Country:US
Practice Address - Phone:410-313-8156
Practice Address - Fax:410-313-8157
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2023-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR253173163WP0808X
MDU01817171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health