Healthcare Provider Details

I. General information

NPI: 1548507684
Provider Name (Legal Business Name): DEREK T DEE MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD SUITE 250
BEVERLY HILLS CA
90211-2142
US

IV. Provider business mailing address

14 AMBER SKY DR
RANCHO PALOS VERDES CA
90275-5024
US

V. Phone/Fax

Practice location:
  • Phone: 310-408-5345
  • Fax:
Mailing address:
  • Phone: 310-408-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA65423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA65423
License Number StateCA

VIII. Authorized Official

Name: DR. DEREK T DEE
Title or Position: PRESIDENT
Credential: MD
Phone: 310-408-5345