Healthcare Provider Details

I. General information

NPI: 1255362406
Provider Name (Legal Business Name): LYG, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE STE 105
NEWPORT BEACH CA
92660-7710
US

IV. Provider business mailing address

1401 AVOCADO AVE STE 105
NEWPORT BEACH CA
92660-7710
US

V. Phone/Fax

Practice location:
  • Phone: 949-718-9292
  • Fax: 949-718-9293
Mailing address:
  • Phone: 949-718-9292
  • Fax: 949-718-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG048746
License Number StateCA

VIII. Authorized Official

Name: DR. LINCOLN S YEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-718-9292