Provider Demographics
NPI:1316076490
Name:LEE, STEPHEN JUNHO (NMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JUNHO
Last Name:LEE
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N ARIZONA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6739
Mailing Address - Country:US
Mailing Address - Phone:602-571-6550
Mailing Address - Fax:
Practice Address - Street 1:777 N ARIZONA AVE STE 10
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6739
Practice Address - Country:US
Practice Address - Phone:602-571-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-908175F00000X
WANT60524064175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-1044696Medicare UPIN