Provider Demographics
NPI:1851471031
Name:LEE, AMY B (LAC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2320 WOOLSEY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1974
Mailing Address - Country:US
Mailing Address - Phone:510-486-1988
Mailing Address - Fax:510-843-7379
Practice Address - Street 1:2320 WOOLSEY ST STE 100
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1974
Practice Address - Country:US
Practice Address - Phone:510-486-1988
Practice Address - Fax:510-843-7379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6445171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist