Provider Demographics
NPI:1689950487
Name:LEE, ANGEL (DC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21580 STEVENS CREEK BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1244
Mailing Address - Country:US
Mailing Address - Phone:408-963-9908
Mailing Address - Fax:
Practice Address - Street 1:21580 STEVENS CREEK BLVD
Practice Address - Street 2:STE 110
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-1244
Practice Address - Country:US
Practice Address - Phone:408-963-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31996111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor