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NPI Code Detail

MEDICARE: DR. CALEB DAEKYU LEE L.AC,OMD, PMHNP-BC

MEDICARE: DR. CALEB DAEKYU LEE L.AC,OMD, PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerR253173MD
2171100000XAcupuncturistU01817MD

General Provider Information

NPI Number : 1649413758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CALEB DAEKYU LEE L.AC,OMD, PMHNP-BC
Provider Business Mailing Address
First Line : 9861 BROKEN LAND PKWY STE 100
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3031
Country : US
Telephone Number : 410-213-5233
Fax Number : 410-213-5233
Provider Business Practice Location Address
First Line : 9861 BROKEN LAND PKWY STE 100
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3031
Country : US
Telephone Number : 410-213-5233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2009
Last Update Date : 10/06/2025

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