Provider Demographics
NPI:1063993160
Name:LEE, JAEOK LUCAS (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:JAEOK
Middle Name:LUCAS
Last Name:LEE
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ALTON CT APT 231
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4186
Mailing Address - Country:US
Mailing Address - Phone:301-821-7703
Mailing Address - Fax:
Practice Address - Street 1:130 ALTON CT APT 231
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4186
Practice Address - Country:US
Practice Address - Phone:301-821-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02525171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist