Provider Demographics
NPI:1952145104
Name:LEE, JOO YEB
Entity type:Individual
Prefix:MR
First Name:JOO YEB
Middle Name:
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 1:901 RUSSELL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-6226
Mailing Address - Country:US
Mailing Address - Phone:301-448-7405
Mailing Address - Fax:240-246-0095
Practice Address - Street 1:901 RUSSELL AVE STE 202
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-6226
Practice Address - Country:US
Practice Address - Phone:301-448-7405
Practice Address - Fax:240-246-0095
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01686171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty