Healthcare Provider Details

I. General information

NPI: 1205952298
Provider Name (Legal Business Name): SAE EUN LEE O.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S MARYLAND PKWY
LAS VEGAS NV
89104-1736
US

IV. Provider business mailing address

1223 S MARYLAND PKWY
LAS VEGAS NV
89104-1736
US

V. Phone/Fax

Practice location:
  • Phone: 702-386-2828
  • Fax: 702-386-2831
Mailing address:
  • Phone: 702-386-2828
  • Fax: 702-386-2831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number40
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: