Healthcare Provider Details

I. General information

NPI: 1649228073
Provider Name (Legal Business Name): JANICE LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

1635 DIVISADERO STREET, SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3242
  • Fax: 415-476-0665
Mailing address:
  • Phone: 415-476-4029
  • Fax: 415-476-4150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number41942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: