Healthcare Provider Details

I. General information

NPI: 1003773417
Provider Name (Legal Business Name): EUN YOUNG LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13975 CONNECTICUT AVE STE 209
SILVER SPRING MD
20906-2921
US

IV. Provider business mailing address

808 FORDHAM ST
ROCKVILLE MD
20850-1018
US

V. Phone/Fax

Practice location:
  • Phone: 240-401-9773
  • Fax:
Mailing address:
  • Phone: 240-401-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03287
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: