MEDICARE: VICKY 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	15924	CA
2	171100000X	Acupuncturist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15924	OTHER	CA	CALIFORNIA ACUPUNCTURE BOARD

General Provider Information

NPI Number	:	1093135303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKY LEE L.AC.

Provider Business Mailing Address
First Line	:	1906 N. HAMILTON ST. STE E
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-4113
Country	:	US
Telephone Number	:	804-200-4054
Fax Number	:	619-795-4423

Provider Business Practice Location Address
First Line	:	1906 N HAMILTON ST. STE E
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-4113
Country	:	US
Telephone Number	:	804-200-4054
Fax Number	:	619-795-4423

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

Provider Enumeration Date	:	04/25/2014
Last Update Date	:	03/16/2018

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