Provider Demographics
NPI:1962848176
Name:LEE, KATHLEEN HO (MTCM, LAC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:HO
Last Name:LEE
Suffix:
Gender:F
Credentials:MTCM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HAGAR CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1030
Mailing Address - Country:US
Mailing Address - Phone:831-708-8832
Mailing Address - Fax:
Practice Address - Street 1:501 MISSION ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3661
Practice Address - Country:US
Practice Address - Phone:831-708-8832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15202171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist