Provider Demographics
NPI:1962662494
Name:LEE, HOON BYUNG
Entity Type:Individual
Prefix:
First Name:HOON
Middle Name:BYUNG
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 1:3525 MALL BLVD STE 5AB
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4752
Mailing Address - Country:US
Mailing Address - Phone:847-920-9815
Mailing Address - Fax:
Practice Address - Street 1:3525 MALL BLVD STE 5AB
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4752
Practice Address - Country:US
Practice Address - Phone:847-920-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000788171100000X
GA515171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist