Basic Information
| Provider Information | |||||||||
| NPI: | 1609467570 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEE | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | CHEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11349 ANTONIO | ||||||||
| Address2: | |||||||||
| City: | STANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906803377 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11180 WARNER AVE STE 455 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927087505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148936008 | ||||||||
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| ProviderEnumerationDate: | 02/02/2021 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1182012 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.