MEDICARE: MR. YOUNG SEO LEE L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	U01683	MD

General Provider Information

NPI Number	:	1609195825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. YOUNG SEO LEE L.AC

Provider Business Mailing Address
First Line	:	9062 CHEVROLET DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4018
Country	:	US
Telephone Number	:	410-300-0693
Fax Number	:	410-796-4377

Provider Business Practice Location Address
First Line	:	9062 CHEVROLET DR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4018
Country	:	US
Telephone Number	:	410-300-0693
Fax Number	:	410-796-4377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	05/27/2010

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