MEDICARE: ANNJI Y. LEE A.C.

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	AC6358	CA

General Provider Information

NPI Number	:	1023264025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNJI Y. LEE A.C.

Provider Business Mailing Address
First Line	:	1511 4TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2310
Country	:	US
Telephone Number	:	310-899-1166
Fax Number	:	310-899-1166

Provider Business Practice Location Address
First Line	:	1511 4TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90401-2310
Country	:	US
Telephone Number	:	310-899-1166
Fax Number	:	310-899-1166

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	03/30/2012

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