Provider Demographics
NPI:1124349147
Name:UNIVERSITY OF CALIFORNIA, IRVINE, DEPARTMENT OF UROLOGY
Entity type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, IRVINE, DEPARTMENT OF UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HAK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-342-1257
Mailing Address - Street 1:3099 W CHAPMAN AVE
Mailing Address - Street 2:SUITE #457
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-1712
Mailing Address - Country:US
Mailing Address - Phone:858-342-1257
Mailing Address - Fax:
Practice Address - Street 1:333 THE CITY BOULEVARD WEST
Practice Address - Street 2:SUITE 2100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:858-342-1257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106612282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital