Provider Demographics
NPI:1265693691
Name:LEE, KATHERINE BAO-SHIAN (MD, MA)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BAO-SHIAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD, MA
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:BAO-SHIAN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MA
Mailing Address - Street 1:24431 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7641
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
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120778207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology