MEDICARE: DR. JEANNIE LEE DAIRO DACM, LAC

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	19201	CA

General Provider Information

NPI Number	:	1194464214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNIE LEE DAIRO DACM, LAC

Provider Business Mailing Address
First Line	:	245 CLEMENT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 CLEMENT ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-2407
Country	:	US
Telephone Number	:	415-387-9738
Fax Number	:

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

Provider Enumeration Date	:	05/27/2022
Last Update Date	:	05/27/2022

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