Healthcare Provider Details

I. General information

NPI: 1609965532
Provider Name (Legal Business Name): KYUNG R LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 BUSH ST
SAN FRANCISCO CA
94109-5611
US

IV. Provider business mailing address

2555 OCEAN AVE STE 204
SAN FRANCISCO CA
94132-1645
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-8888
  • Fax:
Mailing address:
  • Phone: 415-406-1333
  • Fax: 415-406-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA49227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: