MEDICARE: JEN H LEE AC4758

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	AC4758	CA

General Provider Information

NPI Number	:	1043512254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEN H LEE AC4758

Provider Business Mailing Address
First Line	:	2197 CUESTA DR
Second Line	:
City	:	MILPITAS
State	:	CA
Zip	:	95035-7864
Country	:	US
Telephone Number	:	408-409-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E. CALAVERAS BLVD
Second Line	:	SUITE #200
City	:	MILPITAS
State	:	CA
Zip	:	95035-7707
Country	:	US
Telephone Number	:	408-372-5492
Fax Number	:

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

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	11/22/2010

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Directions to “ JEN H LEE AC4758” Practice Location

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