Organization
COASTAL COMMUNITIES PHYSICIAN NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JU HUAN LEE M.D. (MEDICAL DIRECTOR)
(661) 327-4411
Entity
Organization
Contact information
Practice address
35 CASA ST STE 170, SAN LUIS OBISPO, CA 93405-1887
(805) 549-0677
(805) 549-7588
Mailing address
4580 CALIFORNIA AVE, BAKERSFIELD, CA 93309-1104
(805) 549-0677
(805) 549-7588
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
30221170
CA
Other
Enumeration date
06/04/2007
Last updated
07/21/2015
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