Healthcare Provider Details

I. General information

NPI: 1467373431
Provider Name (Legal Business Name): KYUNG AE LEE ACUPUNTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 303
TAPPAN NY
10983-2117
US

IV. Provider business mailing address

2405 6TH ST
FORT LEE NJ
07024-7838
US

V. Phone/Fax

Practice location:
  • Phone: 845-680-6294
  • Fax:
Mailing address:
  • Phone: 551-500-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: