Provider Demographics
NPI:1821542267
Name:LEE, SOONG HO
Entity Type:Individual
Prefix:
First Name:SOONG HO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21538 23RD RD
Mailing Address - Street 2:FL 2
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 E 40TH ST
Practice Address - Street 2:SUITE 701
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-872-1745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001703171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist