Provider Demographics
NPI:1023264025
Name:LEE, ANNJI Y (AC)
Entity type:Individual
Prefix:
First Name:ANNJI
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:ANNJI
Other - Middle Name:Y
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AC
Mailing Address - Street 1:1511 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2310
Mailing Address - Country:US
Mailing Address - Phone:310-899-1166
Mailing Address - Fax:310-899-1166
Practice Address - Street 1:1511 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2310
Practice Address - Country:US
Practice Address - Phone:310-899-1166
Practice Address - Fax:310-899-1166
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist