MEDICARE: SANG HWA LEE ACUPUNCTURIST

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	NCCA011612	CO

General Provider Information

NPI Number	:	1225210263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANG HWA LEE ACUPUNCTURIST

Provider Business Mailing Address
First Line	:	1870 DUBLIN BLVD # A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3101
Country	:	US
Telephone Number	:	719-550-0226
Fax Number	:	719-597-8016

Provider Business Practice Location Address
First Line	:	1870 DUBLIN BLVD STE A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1264
Country	:	US
Telephone Number	:	719-550-0226
Fax Number	:	719-597-8016

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

Provider Enumeration Date	:	12/01/2007
Last Update Date	:	02/14/2008

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