Provider Demographics
NPI:1669568457
Name:DEE, DEREK T (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:T
Last Name:DEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 CENTER AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-9118
Mailing Address - Country:US
Mailing Address - Phone:562-430-3561
Mailing Address - Fax:562-318-3048
Practice Address - Street 1:7801 CENTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-9118
Practice Address - Country:US
Practice Address - Phone:562-430-3561
Practice Address - Fax:562-318-3048
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65423207X00000X
CAA65423A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A654230Medicaid
CAA65423OtherCA LICENSE
CA000A654230Medicaid
CAWA65423AMedicare PIN
CAH53653Medicare UPIN
CA0226020002Medicare NSC