Provider Demographics
NPI:1235377664
Name:LEE, EDWARD HANIEL (AC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:HANIEL
Last Name:LEE
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 VAN NUYS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-2453
Mailing Address - Country:US
Mailing Address - Phone:323-640-2666
Mailing Address - Fax:
Practice Address - Street 1:8780 VAN NUYS BLVD STE A
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-2453
Practice Address - Country:US
Practice Address - Phone:323-640-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12264171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist