Provider Demographics
NPI:1700200037
Name:LEE, MILTON (LAC)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 MISSION ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2063
Mailing Address - Country:US
Mailing Address - Phone:650-557-3818
Mailing Address - Fax:
Practice Address - Street 1:6150 MISSION ST
Practice Address - Street 2:SUITE 111
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-2063
Practice Address - Country:US
Practice Address - Phone:650-557-3818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15449171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist