Provider Demographics
NPI:1891781175
Name:FEE, JANIS D (MD)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:D
Last Name:FEE
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 1:3111 N TUSTIN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1750
Mailing Address - Country:US
Mailing Address - Phone:714-282-1892
Mailing Address - Fax:714-282-9682
Practice Address - Street 1:3111 N TUSTIN ST
Practice Address - Street 2:SUITE 250
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1750
Practice Address - Country:US
Practice Address - Phone:714-282-1892
Practice Address - Fax:714-282-9682
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G733290Medicaid
CAF30804Medicare UPIN
CAWG73329CMedicare ID - Type Unspecified