# COASTAL COMMUNITIES PHYSICIAN NETWORK, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275735011
- **Authorized official:** DR. JU HUAN LEE M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (661) 327-4411

## Contact information

- **Practice address:** 35 CASA ST STE 170, SAN LUIS OBISPO, CA 93405-1887
- **Practice address phone:** (805) 549-0677
- **Practice address fax:** (805) 549-7588
- **Mailing address:** 4580 CALIFORNIA AVE, BAKERSFIELD, CA 93309-1104
- **Mailing address phone:** (805) 549-0677
- **Mailing address fax:** (805) 549-7588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 30221170 | CA | Yes |

## Other

- **Enumeration date:** 06/04/2007
- **Last updated:** 07/21/2015