Provider Demographics
NPI:1235120734
Name:LEE-HATA, NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:LEE-HATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 SHADY GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6818
Mailing Address - Country:US
Mailing Address - Phone:949-233-8897
Mailing Address - Fax:714-741-3660
Practice Address - Street 1:12100 EUCLID ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-3304
Practice Address - Country:US
Practice Address - Phone:714-741-3665
Practice Address - Fax:714-741-3660
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI24023Medicare UPIN
CAWA87025FMedicare ID - Type Unspecified