Healthcare Provider Details

I. General information

NPI: 1356501100
Provider Name (Legal Business Name): DONG HEUN LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE STE S380
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

513 PARNASSUS AVE STE S380
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-9362
  • Fax: 415-476-9364
Mailing address:
  • Phone: 415-502-1811
  • Fax: 415-476-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC168056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD432759
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD432759
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC168056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: