Provider Demographics
NPI:1134412539
Name:LEE, YOUNG HO (MS)
Entity type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:HO
Last Name:LEE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:530 BROAD ST.
Mailing Address - Street 2:2ND FL.
Mailing Address - City:CARLSTADT
Mailing Address - State:NJ
Mailing Address - Zip Code:07072
Mailing Address - Country:US
Mailing Address - Phone:347-551-0992
Mailing Address - Fax:201-933-1216
Practice Address - Street 1:530 BROAD ST.
Practice Address - Street 2:2ND FL.
Practice Address - City:CARLSTADT
Practice Address - State:NJ
Practice Address - Zip Code:07072
Practice Address - Country:US
Practice Address - Phone:347-551-0992
Practice Address - Fax:201-933-1216
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00049100171100000X
NY3135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist