Provider Demographics
NPI:1083736862
Name:LEE, THOMAS G (LICENSED ACUPUNCTURI)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:LEE
Suffix:
Gender:M
Credentials:LICENSED ACUPUNCTURI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HUNTINGTON DRIVE
Mailing Address - Street 2:SUITE #214
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4970
Mailing Address - Country:US
Mailing Address - Phone:626-441-6639
Mailing Address - Fax:626-441-6399
Practice Address - Street 1:2130 HUNTINGTON DRIVE
Practice Address - Street 2:SUITE #214
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4970
Practice Address - Country:US
Practice Address - Phone:626-441-6639
Practice Address - Fax:626-441-6399
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2254171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist