Healthcare Provider Details

I. General information

NPI: 1669851556
Provider Name (Legal Business Name): MICHAEL JOO LEE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 LARKIN ST
SAN FRANCISCO CA
94109-7149
US

IV. Provider business mailing address

451 KANSAS ST UNIT 558
SAN FRANCISCO CA
94107-2218
US

V. Phone/Fax

Practice location:
  • Phone: 415-589-7353
  • Fax:
Mailing address:
  • Phone: 617-331-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number102470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: