MEDICARE: MR. SEUNG-WON LEE L.AC

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	15673	CA

General Provider Information

NPI Number	:	1538590336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEUNG-WON LEE L.AC

Provider Business Mailing Address
First Line	:	5306 FIOLI LOOP
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94582-6012
Country	:	US
Telephone Number	:	510-610-0471
Fax Number	:

Provider Business Practice Location Address
First Line	:	5306 FIOLI LOOP
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94582-6012
Country	:	US
Telephone Number	:	510-610-0471
Fax Number	:

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

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	12/03/2013

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Directions to “ MR. SEUNG-WON LEE L.AC” Practice Location

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