Provider Demographics
NPI:1417015256
Name:LEE, SEUNG JAE (PHD,MAC,DOM, LAC AP)
Entity type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:JAE
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD,MAC,DOM, LAC AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:781-995-4311
Mailing Address - Fax:781-995-0436
Practice Address - Street 1:223 SALEM ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-995-4311
Practice Address - Fax:781-995-0436
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA468171100000X
FLAP2274171100000X
NY004318-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist