Healthcare Provider Details

I. General information

NPI: 1003259284
Provider Name (Legal Business Name): MIMI C LEE, MD PHD, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ALICE B TOKLAS PL UNIT 708
SAN FRANCISCO CA
94109-6962
US

IV. Provider business mailing address

151 ALICE B. TOKLAS PLACE
SAN FRANCISCO CA
94109
US

V. Phone/Fax

Practice location:
  • Phone: 415-846-9989
  • Fax: 704-973-0815
Mailing address:
  • Phone: 415-846-9989
  • Fax: 704-973-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA76994
License Number StateCA

VIII. Authorized Official

Name: DR. MIMI C. LEE
Title or Position: OWNER
Credential: MDPHD
Phone: 415-846-9989