=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285005843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HSUN LEE MS TCM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2015
-----------------------------------------------------
Last Update Date | 10/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6055 MERIDIAN AVE STE 30
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95120-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-446-1996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4683 VENTURA AVE 6055 MERIDIAN AVE, STE 30
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95111-2678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-446-1996
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 16654
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------