Provider Demographics
NPI:1801155528
Name:LEE, JEAN SOONHA (LAC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:SOONHA
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 FRANKLIN ST
Mailing Address - Street 2:3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-6177
Mailing Address - Country:US
Mailing Address - Phone:646-522-8034
Mailing Address - Fax:
Practice Address - Street 1:169 WYTHE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-8676
Practice Address - Country:US
Practice Address - Phone:718-930-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002708171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist