Healthcare Provider Details

I. General information

NPI: 1871712950
Provider Name (Legal Business Name): LEE LIU HUANG L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 76TH AVE SE STE 212
MERCER ISLAND WA
98040-2744
US

IV. Provider business mailing address

2448 76TH AVE SE STE 212
MERCER ISLAND WA
98040-2744
US

V. Phone/Fax

Practice location:
  • Phone: 206-462-1330
  • Fax: 425-449-4085
Mailing address:
  • Phone: 206-462-1330
  • Fax: 425-449-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00001890
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: