Healthcare Provider Details

I. General information

NPI: 1780406157
Provider Name (Legal Business Name): JOSEPHINE SUSAN LEE NP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # L1556
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

ATTN: BERKELEY CLINIC NP 510 17TH STREET
OAKLAND CA
94612-1553
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4906
  • Fax:
Mailing address:
  • Phone: 510-318-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95032640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: