Provider Demographics
NPI:1497293310
Name:LEE CHEN, ANGELA (LAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LEE CHEN
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 1:607 BRIARWOOD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-6733
Mailing Address - Country:US
Mailing Address - Phone:843-655-4629
Mailing Address - Fax:
Practice Address - Street 1:607 BRIARWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-6733
Practice Address - Country:US
Practice Address - Phone:843-655-4629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-11
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCACUP285171100000X
NY1141171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist