Provider Demographics
NPI:1023557444
Name:AMERICAN FERTILITY MEDICAL CENTER CORPORATION
Entity Type:Organization
Organization Name:AMERICAN FERTILITY MEDICAL CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-476-4863
Mailing Address - Street 1:1306 CAMERONS AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2205
Mailing Address - Country:US
Mailing Address - Phone:626-476-4863
Mailing Address - Fax:
Practice Address - Street 1:2 HUGHES
Practice Address - Street 2:SUITE 175
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2056
Practice Address - Country:US
Practice Address - Phone:626-476-4863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15822171100000X
CA207Q00000X, 207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty