Healthcare Provider Details

I. General information

NPI: 1578492187
Provider Name (Legal Business Name): MISA LEE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VAN NESS AVE STE 154
SAN FRANCISCO CA
94109-6919
US

IV. Provider business mailing address

121 ALTA RD
OAKLAND CA
94618-2526
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-3269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: