Provider Demographics
NPI:1548936396
Name:LEE, MCKALE YOSHIKI (L AC)
Entity type:Individual
Prefix:
First Name:MCKALE
Middle Name:YOSHIKI
Last Name:LEE
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10641 GREENBRIER RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-6401
Mailing Address - Country:US
Mailing Address - Phone:952-201-8407
Mailing Address - Fax:
Practice Address - Street 1:2110 EAGLE CREEK LN
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-3205
Practice Address - Country:US
Practice Address - Phone:612-504-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1895171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist