MEDICARE: WAYNE W. LEE, D.D.S., INC.

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	1223G0001X	General Practice Dentistry	46489	CA

General Provider Information

NPI Number	:	1306040100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE W. LEE, D.D.S., INC.

Provider Business Mailing Address
First Line	:	6100 GEARY BLVD
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1910
Country	:	US
Telephone Number	:	415-386-0790
Fax Number	:	415-386-0792

Provider Business Practice Location Address
First Line	:	6100 GEARY BLVD
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-1910
Country	:	US
Telephone Number	:	415-386-0790
Fax Number	:	415-386-0792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WAYNE W. LEE
Credential	:	D.D.S.
Telephone Number	:	415-386-0790

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	12/17/2007

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