Provider Demographics
NPI:1083751242
Name:PAO, WENLEE (LAC MA)
Entity Type:Individual
Prefix:MR
First Name:WENLEE
Middle Name:
Last Name:PAO
Suffix:
Gender:M
Credentials:LAC MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2726
Mailing Address - Country:US
Mailing Address - Phone:626-282-4908
Mailing Address - Fax:
Practice Address - Street 1:530 LOMAS SANTA FE DR
Practice Address - Street 2:SUITE M
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1349
Practice Address - Country:US
Practice Address - Phone:858-259-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist