Provider Demographics
NPI:1043512254
Name:LEE, JEN H (AC4758)
Entity type:Individual
Prefix:
First Name:JEN
Middle Name:H
Last Name:LEE
Suffix:
Gender:F
Credentials:AC4758
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 CUESTA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7864
Mailing Address - Country:US
Mailing Address - Phone:408-409-9400
Mailing Address - Fax:
Practice Address - Street 1:500 E. CALAVERAS BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7707
Practice Address - Country:US
Practice Address - Phone:408-372-5492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist