Provider Demographics
NPI:1881012656
Name:KATHERINE BAO-SHIAN LEE, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KATHERINE BAO-SHIAN LEE, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:HALCYON DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-266-0216
Mailing Address - Street 1:57 TIMBERLAND
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2108
Mailing Address - Country:US
Mailing Address - Phone:949-266-0216
Mailing Address - Fax:949-266-0216
Practice Address - Street 1:24431 CALLE DE LA LOUISA
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7641
Practice Address - Country:US
Practice Address - Phone:949-266-0216
Practice Address - Fax:949-266-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120778207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty