Provider Demographics
NPI:1821321449
Name:LEE, CHUL S (LAC)
Entity Type:Individual
Prefix:MR
First Name:CHUL
Middle Name:S
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 1:7150 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3063
Mailing Address - Country:US
Mailing Address - Phone:571-248-4700
Mailing Address - Fax:
Practice Address - Street 1:7150 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3063
Practice Address - Country:US
Practice Address - Phone:571-248-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000239171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist