Healthcare Provider Details

I. General information

NPI: 1093692410
Provider Name (Legal Business Name): ANTHEM WOUND CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 LINCOLN AVE
BUENA PARK CA
90620-4107
US

IV. Provider business mailing address

6888 LINCOLN AVE
BUENA PARK CA
90620-4107
US

V. Phone/Fax

Practice location:
  • Phone: 714-874-6023
  • Fax: 714-828-8424
Mailing address:
  • Phone: 714-874-6023
  • Fax: 714-828-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SOLEDAD O LEE
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 714-828-8400