MEDICARE: JONG HO LEE

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	2014009517	MO

General Provider Information

NPI Number	:	1861803892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONG HO LEE

Provider Business Mailing Address
First Line	:	1958 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-622-8496
Fax Number	:	816-295-1373

Provider Business Practice Location Address
First Line	:	1958 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-622-8496
Fax Number	:	816-295-1373

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	02/10/2023

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Directions to “ JONG HO LEE ” Practice Location

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