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General NPI Number Information
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NPI Number | 1477963148
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Entity Type | Individual
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Provider Name | JIN YOUNG LEE LAC.
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Gender | Male
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Dates
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Enumeration Date | 05/04/2014
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 1288 KIFER RD STE 202
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City | SUNNYVALE
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State | CA
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Zip | 94086-5326
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Country | US
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Telephone | 408-831-3815
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Fax | 408-831-3816
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Provider Business Mailing Address
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Address Line | 1400 BOWE AVE APT 611
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City | SANTA CLARA
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State | CA
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Zip | 95051-3834
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Country | US
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Telephone | 408-660-5921
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Fax | 866-275-7594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 15907
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License Number State | CA
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