Provider Demographics
NPI:1710911284
Name:LEE, DELPHINE JUIHOA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DELPHINE
Middle Name:JUIHOA
Last Name:LEE
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2302
Mailing Address - Country:US
Mailing Address - Phone:310-449-5265
Mailing Address - Fax:310-449-5273
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-449-5265
Practice Address - Fax:310-449-5273
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80992207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA80992OtherLICENSE