Provider Demographics
NPI:1760841944
Name:LEE, YI-TSAN (LAC EAMP)
Entity Type:Individual
Prefix:
First Name:YI-TSAN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 NW FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1702
Mailing Address - Country:US
Mailing Address - Phone:253-343-7567
Mailing Address - Fax:
Practice Address - Street 1:618 NW FOLSOM ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1702
Practice Address - Country:US
Practice Address - Phone:253-343-7567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60628080171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist