Healthcare Provider Details

I. General information

NPI: 1023557444
Provider Name (Legal Business Name): AMERICAN FERTILITY MEDICAL CENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HUGHES SUITE 175
IRVINE CA
92618-2056
US

IV. Provider business mailing address

1306 CAMERONS AVE
ROWLAND HEIGHTS CA
91748-2205
US

V. Phone/Fax

Practice location:
  • Phone: 626-476-4863
  • Fax:
Mailing address:
  • Phone: 626-476-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15822
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. THOMAS T LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-476-4863