Healthcare Provider Details

I. General information

NPI: 1245328822
Provider Name (Legal Business Name): CALVIN Y. LEE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 TARAVAL ST
SAN FRANCISCO CA
94116-1953
US

IV. Provider business mailing address

348 TARAVAL ST
SAN FRANCISCO CA
94116-1953
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-6800
  • Fax: 415-564-2319
Mailing address:
  • Phone: 415-564-6800
  • Fax: 415-564-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number30935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: