Provider Demographics
NPI:1114081981
Name:LEE, YIU FUN DEREK (MD)
Entity Type:Individual
Prefix:
First Name:YIU FUN DEREK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16388 COLIMA RD STE 206
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-5525
Mailing Address - Country:US
Mailing Address - Phone:626-369-1886
Mailing Address - Fax:
Practice Address - Street 1:16388 COLIMA RD STE 206
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-5525
Practice Address - Country:US
Practice Address - Phone:626-369-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G811100Medicaid
CA00G811100Medicaid