Healthcare Provider Details

I. General information

NPI: 1982804001
Provider Name (Legal Business Name): LI-KUN F LEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W ROE BLVD
PATCHOGUE NY
11772-2333
US

IV. Provider business mailing address

PO BOX 40313
GLEN OAKS NY
11004-0313
US

V. Phone/Fax

Practice location:
  • Phone: 516-690-0027
  • Fax:
Mailing address:
  • Phone: 516-690-0027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: LIKUN FANG LEE
Title or Position: LAC
Credential: LAC
Phone: 516-690-0027