Provider Demographics
NPI:1164760575
Name:NORTHERN OC ENT PROPERTIES LLC
Entity Type:Organization
Organization Name:NORTHERN OC ENT PROPERTIES LLC
Other - Org Name:JAMES J. LEE, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-441-0133
Mailing Address - Street 1:1955 SUNNYCREST DR STE 108
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3653
Mailing Address - Country:US
Mailing Address - Phone:714-441-0133
Mailing Address - Fax:714-441-1082
Practice Address - Street 1:1955 SUNNYCREST DR STE 108
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3653
Practice Address - Country:US
Practice Address - Phone:714-441-0133
Practice Address - Fax:714-441-1082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN OC ENT MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201135710289332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47905Medicare UPIN