Provider Demographics
NPI:1841318011
Name:LEE, SANGWON (LAC)
Entity type:Individual
Prefix:MR
First Name:SANGWON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5215
Mailing Address - Country:US
Mailing Address - Phone:646-642-2908
Mailing Address - Fax:877-719-0709
Practice Address - Street 1:1 FULTON AVE STE 11
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3648
Practice Address - Country:US
Practice Address - Phone:646-642-2908
Practice Address - Fax:516-479-0214
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist