Provider Demographics
NPI:1679566335
Name:LEE, PATRICK KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KEVIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13420 NEWPORT AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3745
Mailing Address - Country:US
Mailing Address - Phone:714-731-0061
Mailing Address - Fax:714-731-0164
Practice Address - Street 1:13420 NEWPORT AVE
Practice Address - Street 2:SUITE G
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3745
Practice Address - Country:US
Practice Address - Phone:714-731-0061
Practice Address - Fax:714-731-0164
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2012-02-22
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Provider Licenses
StateLicense IDTaxonomies
CAG74804207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF64417Medicare UPIN