Healthcare Provider Details

I. General information

NPI: 1194091199
Provider Name (Legal Business Name): BENJAMIN J LEE MD, MAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2012
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE # B1
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

6560 FANNIN ST STE 2206
HOUSTON TX
77030-2726
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2507
  • Fax:
Mailing address:
  • Phone: 713-790-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA127737
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA127737
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR6224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: