Healthcare Provider Details

I. General information

NPI: 1093106569
Provider Name (Legal Business Name): CAROL K. LEE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 NORIEGA ST STE 200
SAN FRANCISCO CA
94122-4434
US

IV. Provider business mailing address

1518 NORIEGA ST STE 200
SAN FRANCISCO CA
94122-4434
US

V. Phone/Fax

Practice location:
  • Phone: 415-566-7556
  • Fax: 415-566-8486
Mailing address:
  • Phone: 415-566-7556
  • Fax: 415-566-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG62717
License Number StateCA

VIII. Authorized Official

Name: CAROL K LEE
Title or Position: PEDIATRICIAN
Credential: M.D.
Phone: 415-566-7556