Provider Demographics
NPI:1497887251
Name:DEE, BUNTHAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BUNTHAN
Middle Name:
Last Name:DEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 MANGO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3603
Mailing Address - Country:US
Mailing Address - Phone:909-350-3032
Mailing Address - Fax:
Practice Address - Street 1:8110 MANGO AVE STE 102
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3603
Practice Address - Country:US
Practice Address - Phone:909-350-3032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4660213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV08737Medicare UPIN
CA000E4660Medicare ID - Type UnspecifiedMEDICARE NUMBER