Provider Demographics
NPI:1699733766
Name:LESON, SEAN (DO)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:LESON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12512 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1907
Mailing Address - Country:US
Mailing Address - Phone:714-590-1611
Mailing Address - Fax:714-590-1641
Practice Address - Street 1:12512 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1907
Practice Address - Country:US
Practice Address - Phone:714-590-1611
Practice Address - Fax:714-590-1641
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6461207KI0005X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A6461Medicare ID - Type Unspecified
CAF67337Medicare UPIN
CA00AX64610Medicaid