Provider Demographics
NPI:1992126288
Name:K.L.LUNDEEN, LLC
Entity type:Organization
Organization Name:K.L.LUNDEEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:701-361-3131
Mailing Address - Street 1:2505 REVERE CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-3253
Mailing Address - Country:US
Mailing Address - Phone:701-361-3131
Mailing Address - Fax:
Practice Address - Street 1:3231 SUPERIOR LN STE A2
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1939
Practice Address - Country:US
Practice Address - Phone:701-361-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02129302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization