Provider Demographics
NPI:1528422912
Name:LEE, YOUNG JU (NMD)
Entity type:Individual
Prefix:DR
First Name:YOUNG JU
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 N MAY UNIT 37
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-7503
Mailing Address - Country:US
Mailing Address - Phone:480-442-1347
Mailing Address - Fax:
Practice Address - Street 1:1845 S DOBSON RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5661
Practice Address - Country:US
Practice Address - Phone:480-433-4051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-1540175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath