MEDICARE: CASEY PAUL LEE DDS (CANDIDATE 2018)

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DDS104492	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DDS104492	CA

General Provider Information

NPI Number	:	1003315458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY PAUL LEE DDS (CANDIDATE 2018)

Provider Business Mailing Address
First Line	:	348 TARAVAL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1953
Country	:	US
Telephone Number	:	415-564-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	348 TARAVAL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1953
Country	:	US
Telephone Number	:	415-564-6800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	04/08/2026

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