Healthcare Provider Details

I. General information

NPI: 1437229820
Provider Name (Legal Business Name): DUK JOON LEE OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S MARYLAND PKWY #B
LAS VEGAS NV
89109-1579
US

IV. Provider business mailing address

2710 S MARYLAND PKWY #B
LAS VEGAS NV
89109-1579
US

V. Phone/Fax

Practice location:
  • Phone: 702-734-6903
  • Fax:
Mailing address:
  • Phone: 702-734-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: