Provider Demographics
NPI:1902182645
Name:LEE, KYLEEN LEI MING (LAC)
Entity Type:Individual
Prefix:MISS
First Name:KYLEEN
Middle Name:LEI MING
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:18870 8TH AVE NE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6233
Mailing Address - Country:US
Mailing Address - Phone:360-394-4357
Mailing Address - Fax:360-394-7972
Practice Address - Street 1:18870 8TH AVE NE
Practice Address - Street 2:SUITE 108
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6233
Practice Address - Country:US
Practice Address - Phone:360-394-4357
Practice Address - Fax:360-394-7972
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 60250736171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist