Provider Demographics
NPI:1780417089
Name:LEE, DELVIN
Entity type:Individual
Prefix:
First Name:DELVIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARSHALL B. KETCHUM UNIVERSITY 2575 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1699
Mailing Address - Country:US
Mailing Address - Phone:909-539-5766
Mailing Address - Fax:
Practice Address - Street 1:MARSHALL B. KETCHUM UNIVERSITY 2575 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1699
Practice Address - Country:US
Practice Address - Phone:909-539-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program