Provider Demographics
NPI:1164860342
Name:LEE, WAYNE QUANG (LAC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:QUANG
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9834 GIOVANE ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1802
Mailing Address - Country:US
Mailing Address - Phone:626-228-6044
Mailing Address - Fax:
Practice Address - Street 1:9834 GIOVANE ST
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1802
Practice Address - Country:US
Practice Address - Phone:626-228-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15360171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist