Provider Demographics
NPI:1295286441
Name:LEE, AMANDA ZHOU (LAC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ZHOU
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ZHOUIE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2777 YULUPA AVE
Mailing Address - Street 2:STE 291
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8584
Mailing Address - Country:US
Mailing Address - Phone:707-849-4469
Mailing Address - Fax:
Practice Address - Street 1:966 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4814
Practice Address - Country:US
Practice Address - Phone:707-849-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17168171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist