Provider Demographics
NPI:1689998593
Name:LEE, TAEK WON (LAC)
Entity Type:Individual
Prefix:
First Name:TAEK
Middle Name:WON
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 224TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2007
Mailing Address - Country:US
Mailing Address - Phone:917-482-9129
Mailing Address - Fax:
Practice Address - Street 1:5703 224TH ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2007
Practice Address - Country:US
Practice Address - Phone:917-482-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000953171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist