MEDICARE: MISA LEE

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1578492187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISA LEE

Provider Business Mailing Address
First Line	:	121 ALTA RD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-2526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 VAN NESS AVE STE 154
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-6919
Country	:	US
Telephone Number	:	415-600-3269
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ MISA LEE ” Practice Location

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