=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053634832
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANG MIN LEE D.C., L.AC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2010
-----------------------------------------------------
Last Update Date | 03/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8808 CENTRE PARK DR SUITE 208
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-997-0987
-----------------------------------------------------
Fax | 410-715-2280
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8808 CENTRE PARK DR SUITE 208
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-2126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-997-0987
-----------------------------------------------------
Fax | 410-997-1250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | U02139
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | S03614
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------