Healthcare Provider Details

I. General information

NPI: 1962513465
Provider Name (Legal Business Name): JOHN S LEAN M D F R C S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA #207
LAGUNA HILLS CA
92653-3107
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA #207
LAGUNA HILLS CA
92653-3107
US

V. Phone/Fax

Practice location:
  • Phone: 949-707-5125
  • Fax: 949-707-5129
Mailing address:
  • Phone: 949-707-5125
  • Fax: 949-707-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA41624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberA41624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: