Individual
WIEKE H LIEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17601 17TH ST # 10, TUSTIN, CA 92780-1949
(714) 790-0005
(714) 699-2444
Mailing address
17601 17TH ST # 110, TUSTIN, CA 92780-1949
(714) 790-0005
(714) 699-2444
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G70387
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G730871
—
CA
01
—
G70387
MEDICAL LICENSE
CA
Enumeration date
07/03/2006
Last updated
09/14/2023
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