MEDICARE: KEVIN KUANG LEE D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	104726	CA

General Provider Information

NPI Number	:	1689292047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KUANG LEE D.D.S.

Provider Business Mailing Address
First Line	:	1848 NORIEGA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4324
Country	:	US
Telephone Number	:	415-564-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1848 NORIEGA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4324
Country	:	US
Telephone Number	:	909-896-1877
Fax Number	:

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

Provider Enumeration Date	:	07/11/2020
Last Update Date	:	02/14/2025

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