Provider Demographics
NPI:1093097321
Name:LEE, CHIAYUN JANICE (LAC)
Entity Type:Individual
Prefix:
First Name:CHIAYUN
Middle Name:JANICE
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18870 8TH AVE NE # S-108
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6233
Mailing Address - Country:US
Mailing Address - Phone:360-394-4357
Mailing Address - Fax:360-394-7972
Practice Address - Street 1:18870 8TH AVE NE # S-108
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6233
Practice Address - Country:US
Practice Address - Phone:360-394-4357
Practice Address - Fax:360-394-7972
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60241995171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist