Healthcare Provider Details

I. General information

NPI: 1972235125
Provider Name (Legal Business Name): SUSAN SUNHA LEE DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 SUMMIT ST STE A
OAKLAND CA
94609-3482
US

IV. Provider business mailing address

810 PROWSHEAD LN
FOSTER CITY CA
94404-3772
US

V. Phone/Fax

Practice location:
  • Phone: 510-227-8099
  • Fax:
Mailing address:
  • Phone: 201-725-2075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number105822
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number105822
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: