MEDICARE: HYO SUB LEE

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	18006	CA

General Provider Information

NPI Number	:	1730675380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYO SUB LEE

Provider Business Mailing Address
First Line	:	24017 OAK KNOLL CIR
Second Line	:
City	:	LOS ALTOS HILLS
State	:	CA
Zip	:	94022-5138
Country	:	US
Telephone Number	:	408-529-4947
Fax Number	:

Provider Business Practice Location Address
First Line	:	24017 OAK KNOLL CIR
Second Line	:
City	:	LOS ALTOS HILLS
State	:	CA
Zip	:	94022-5138
Country	:	US
Telephone Number	:	408-529-4947
Fax Number	:

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

Provider Enumeration Date	:	07/06/2018
Last Update Date	:	07/06/2018

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Directions to “ HYO SUB LEE ” Practice Location

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