Provider Demographics
NPI:1972848596
Name:LEE, KO CHIN
Entity Type:Individual
Prefix:MS
First Name:KO CHIN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:TALMAGE
Mailing Address - State:CA
Mailing Address - Zip Code:95481-0089
Mailing Address - Country:US
Mailing Address - Phone:162-625-7811
Mailing Address - Fax:
Practice Address - Street 1:101 W CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4856
Practice Address - Country:US
Practice Address - Phone:626-257-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9138171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist