Provider Demographics
NPI:1306396221
Name:LEE, BUP K (LAC)
Entity type:Individual
Prefix:
First Name:BUP
Middle Name:K
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 1:3090 S JAMAICA CT STE 308
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2628
Mailing Address - Country:US
Mailing Address - Phone:303-210-5717
Mailing Address - Fax:
Practice Address - Street 1:3090 S JAMAICA CT # 308
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-2658
Practice Address - Country:US
Practice Address - Phone:303-210-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002476171100000X
CAAC 17289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17289OtherACUPUNCTURE