Healthcare Provider Details

I. General information

NPI: 1679808265
Provider Name (Legal Business Name): ANNA HYUN LEE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MAIN ST SUITE 5
HACKENSACK NJ
07601-5017
US

IV. Provider business mailing address

920 MAIN ST SUITE 5
HACKENSACK NJ
07601-5017
US

V. Phone/Fax

Practice location:
  • Phone: 201-530-0060
  • Fax: 201-530-0061
Mailing address:
  • Phone: 201-530-0060
  • Fax: 201-530-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00601100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: