Provider Demographics
NPI:1811268634
Name:LEE, DONGKEUN (L AC(NJ,NY))
Entity type:Individual
Prefix:MR
First Name:DONGKEUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:L AC(NJ,NY)
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:K
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC(NJ,NY)
Mailing Address - Street 1:2000 LINWOOD AVE
Mailing Address - Street 2:APT. 11N
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3086
Mailing Address - Country:US
Mailing Address - Phone:201-862-1110
Mailing Address - Fax:201-862-1154
Practice Address - Street 1:765 TEANECK RD
Practice Address - Street 2:GROUND FL.
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4248
Practice Address - Country:US
Practice Address - Phone:201-862-1110
Practice Address - Fax:201-862-1154
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00081200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist