Provider Demographics
NPI:1538288584
Name:LEE, PAUL DAVID (LAC, DIPL ACU)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC, DIPL ACU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2243
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-2243
Mailing Address - Country:US
Mailing Address - Phone:805-709-1208
Mailing Address - Fax:
Practice Address - Street 1:12171 HIGHWAY 9
Practice Address - Street 2:UNIT # 1
Practice Address - City:BOULDER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95006-9467
Practice Address - Country:US
Practice Address - Phone:805-709-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9195171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist