Provider Demographics
NPI:1477851368
Name:LEE, DIANA HAE (LA C)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:HAE
Last Name:LEE
Suffix:
Gender:F
Credentials:LA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 S ANAHEIM BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-8520
Mailing Address - Country:US
Mailing Address - Phone:310-422-7027
Mailing Address - Fax:
Practice Address - Street 1:947 S ANAHEIM BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-8520
Practice Address - Country:US
Practice Address - Phone:310-422-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12205247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12205OtherLICENSED ACUPUNCTURIST