MEDICARE: MR. LEON YAN SHAW LEE OMD

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	AC00344	TX

General Provider Information

NPI Number	:	1588716120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEON YAN SHAW LEE OMD

Provider Business Mailing Address
First Line	:	4300 MATLOCK RD
Second Line	:	#101
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5258
Country	:	US
Telephone Number	:	817-274-3627
Fax Number	:	817-303-6554

Provider Business Practice Location Address
First Line	:	4300 MATLOCK RD
Second Line	:	#101
City	:	ARLINGTON
State	:	TX
Zip	:	76018-5258
Country	:	US
Telephone Number	:	817-274-3627
Fax Number	:	817-303-6554

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	09/29/2008

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