Provider Demographics
NPI:1922342054
Name:LEE, GRACE CHIAHUA (LAC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CHIAHUA
Last Name:LEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15596 LANYARD LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-8709
Mailing Address - Country:US
Mailing Address - Phone:626-623-9777
Mailing Address - Fax:
Practice Address - Street 1:15338 CENTRAL AVE # 109
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7658
Practice Address - Country:US
Practice Address - Phone:909-693-4768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14726171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist