Individual provider Active NPI

Soungkyum Lee

  • Acupuncturist
  • New York, NY
National Provider Identifier
1427526722
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
25MZ00130400 Issued in NJ
Practice address
115 W 45TH St Ste 502
New York, NY 10036-4005
Phone
(212) 884-5999
Fax
(212) 457-7155
NPI assigned
Nov 5, 2018
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 25MZ00130400 NJ Primary
Acupuncturist 171100000X 005248 NY

Addresses

Primary practice location

115 W 45TH St Ste 502
New York, NY 10036-4005

Mailing address

115 W 45TH St Ste 502
New York, NY 10036-4005
Phone (201) 364-1066

Other practice location 1

201 Fort Lee Rd Apt A
Leonia, NJ 07605-1900
Phone (201) 364-1066

Other practice location 2

517 Cedar Ln Fl 2
Teaneck, NJ 07666-1710
Phone (201) 347-9393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
25MZ00130400NJMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
East Billow Acupuncture PC Acupuncturist CurrentSince Mar 13, 2022 Accepting new patients
S Lee Acupuncture PC Acupuncturist Current Accepting new patients
East Billow Acupuncture, P.C. Acupuncturist Current Accepting new patients
Abcnj Chiropractic PC PastSince May 16, 2022 Accepting new patients

Locations

517 Cedar Ln
#2
Teaneck, NJ 07666
Phone (201) 347-9393

115 W 45th St
Ste 502
New York, NY 10036
Phone (212) 884-5999

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1427526722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W 45TH ST STE 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100364005",
            "telephone_number": "201-364-1066",
            "fax_number": "201-347-9392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W 45TH ST STE 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100364005",
            "telephone_number": "212-884-5999",
            "fax_number": "212-457-7155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Fort Lee Rd Apt A",
            "address_purpose": "LOCATION",
            "city": "Leonia",
            "state": "NJ",
            "postal_code": "076051900",
            "country_code": "US",
            "telephone_number": "201-364-1066",
            "fax_number": "201-347-9392",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "517 Cedar Ln Fl 2",
            "address_purpose": "LOCATION",
            "city": "Teaneck",
            "state": "NJ",
            "postal_code": "076661710",
            "country_code": "US",
            "telephone_number": "201-347-9393",
            "fax_number": "201-347-9392",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "SOUNGKYUM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-05",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NJ",
            "license": "25MZ00130400",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "005248",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.