Basic Information
Provider Information
NPI: 1104035369
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: JAMES
MiddleName: CHEN-YU
NamePrefix:  
NameSuffix:  
Credential: L.AC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 47185 ARMATA ST
Address2:  
City: FREMONT
State: CA
PostalCode: 945397438
CountryCode: US
TelephoneNumber: 5102260603
FaxNumber:  
Practice Location
Address1: 1669 S MAIN ST
Address2:  
City: MILPITAS
State: CA
PostalCode: 950356200
CountryCode: US
TelephoneNumber: 4089427479
FaxNumber: 4089427416
Other Information
ProviderEnumerationDate: 05/22/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X11704CAY Other Service ProvidersAcupuncturist 

No ID Information.


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