Provider Demographics
NPI:1417737933
Name:LEE, VIRGINIA HYANNIS (DACM, LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:HYANNIS
Last Name:LEE
Suffix:
Gender:F
Credentials:DACM, LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7860 WESTSIDE DR APT 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1213
Mailing Address - Country:US
Mailing Address - Phone:650-430-1816
Mailing Address - Fax:
Practice Address - Street 1:3080 N PARK WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3625
Practice Address - Country:US
Practice Address - Phone:650-430-1816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19879171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist