MEDICARE: ERIC YIN-REN 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	AC9772	CA

General Provider Information

NPI Number	:	1801026497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC YIN-REN LEE L.AC.

Provider Business Mailing Address
First Line	:	12660 RIVERSIDE DR STE 325
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3404
Country	:	US
Telephone Number	:	818-506-0485
Fax Number	:	818-506-3889

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR STE 325
Second Line	:
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3404
Country	:	US
Telephone Number	:	818-506-0485
Fax Number	:	818-506-3889

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

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	07/17/2009

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