Provider Demographics
NPI:1750624128
Name:LEE, JIYUN (LAC)
Entity type:Individual
Prefix:MISS
First Name:JIYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 HARRINGTON AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1911
Mailing Address - Country:US
Mailing Address - Phone:201-815-7070
Mailing Address - Fax:201-768-7071
Practice Address - Street 1:317 HARRINGTON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1911
Practice Address - Country:US
Practice Address - Phone:201-815-7070
Practice Address - Fax:201-768-7071
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005031171100000X
NJ25MZ00098300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist