Healthcare Provider Details

I. General information

NPI: 1982282752
Provider Name (Legal Business Name): SEAN SHIN HYEOK LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST RM C250
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1001 POTRERO AVENUE BLDG. 5, 1ST FLOOR
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-885-7464
  • Fax:
Mailing address:
  • Phone: 628-206-8020
  • Fax: 628-206-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA180779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: