Healthcare Provider Details

I. General information

NPI: 1013025600
Provider Name (Legal Business Name): ALASKA FAMILY CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE STREET SUITE 210
ANCHORAGE AK
99508-5445
US

IV. Provider business mailing address

4001 DALE STREET SUITE 210
ANCHORAGE AK
99508-5445
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-5888
  • Fax: 907-929-5882
Mailing address:
  • Phone: 907-929-5888
  • Fax: 907-929-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LORETTA LEIH-SHENG LEE
Title or Position: OWNER/MEMBER
Credential: M.D.
Phone: 907-929-5888