MEDICARE: MS. HSUN LEE MS TCM

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	AC 16654	CA

General Provider Information

NPI Number	:	1285005843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HSUN LEE MS TCM

Provider Business Mailing Address
First Line	:	4683 VENTURA AVE
Second Line	:	6055 MERIDIAN AVE, STE 30
City	:	SAN JOSE
State	:	CA
Zip	:	95111-2678
Country	:	US
Telephone Number	:	408-446-1996
Fax Number	:

Provider Business Practice Location Address
First Line	:	6055 MERIDIAN AVE STE 30
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2700
Country	:	US
Telephone Number	:	408-446-1996
Fax Number	:

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

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	10/08/2015

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