Healthcare Provider Details

I. General information

NPI: 1245305838
Provider Name (Legal Business Name): SEAN LESON DO MPH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12512 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-1907
US

IV. Provider business mailing address

12512 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-1907
US

V. Phone/Fax

Practice location:
  • Phone: 714-590-1611
  • Fax: 714-590-1641
Mailing address:
  • Phone: 714-590-1611
  • Fax: 714-590-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number20A6461
License Number StateCA

VIII. Authorized Official

Name: DR. SEAN LESON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 714-590-1611