Provider Demographics
NPI:1164684973
Name:LEE, MIMI SHISHOU (MD)
Entity Type:Individual
Prefix:DR
First Name:MIMI
Middle Name:SHISHOU
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17360 BROOKHURST STREET
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3720
Mailing Address - Country:US
Mailing Address - Phone:877-844-0012
Mailing Address - Fax:714-665-4680
Practice Address - Street 1:17360 BROOKHURST STREET
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3720
Practice Address - Country:US
Practice Address - Phone:877-844-0012
Practice Address - Fax:714-665-4680
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1305772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164684973OtherNPI
CA1164684973Medicare UPIN
CA1164684973Medicare NSC
CA1164684973Medicare Oscar/Certification
CA1164684973Medicare PIN