Organization
WIEKE H LIEM, M.D.,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WIEKE H LIEM M.D. (PRESIDENT)
(714) 538-8556
Entity
Organization
Contact information
Practice address
17601 17TH ST STE 110, TUSTIN, CA 92780-1949
(714) 790-0005
(714) 538-1082
Mailing address
1506 E CHAPMAN AVE, ORANGE, CA 92866-2231
(714) 538-8556
(714) 538-1082
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G70387
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G703871
—
CA
01
—
G70387
MEDICAL LICENSE
CA
Enumeration date
05/15/2007
Last updated
08/24/2020
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