Provider Demographics
NPI:1982702429
Name:AUSTIN, LEE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:S
Last Name:AUSTIN
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 1:7365 CARNELIAN ST
Mailing Address - Street 2:STE 137
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-1100
Mailing Address - Country:US
Mailing Address - Phone:909-948-8888
Mailing Address - Fax:909-948-8839
Practice Address - Street 1:7365 CARNELIAN ST
Practice Address - Street 2:STE 137
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-1100
Practice Address - Country:US
Practice Address - Phone:909-948-8888
Practice Address - Fax:909-948-8839
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43777207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G437770Medicaid
CA00G437770Medicaid
CADY693YMedicare PIN