Provider Demographics
NPI:1386686673
Name:LAKE, JEAN L (MD)
Entity Type:Individual
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First Name:JEAN
Middle Name:L
Last Name:LAKE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:2880 ATLANTIC AVE
Mailing Address - Street 2:260
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1714
Mailing Address - Country:US
Mailing Address - Phone:562-490-3580
Mailing Address - Fax:562-490-3584
Practice Address - Street 1:2880 ATLANTIC AVE
Practice Address - Street 2:260
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1714
Practice Address - Country:US
Practice Address - Phone:562-490-3580
Practice Address - Fax:562-490-3584
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG4443872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology