Provider Demographics
NPI:1770236309
Name:MIKYUNG LEE ACUPUNCTURE PC
Entity Type:Organization
Organization Name:MIKYUNG LEE ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MIKYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-300-5990
Mailing Address - Street 1:4021 159TH ST STE 3F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1667
Mailing Address - Country:US
Mailing Address - Phone:646-300-5990
Mailing Address - Fax:
Practice Address - Street 1:4021 159TH ST STE 3F
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1667
Practice Address - Country:US
Practice Address - Phone:646-300-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty