Healthcare Provider Details

I. General information

NPI: 1043873268
Provider Name (Legal Business Name): ANTHONY LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE RM M779
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE RM M779
SAN FRANCISCO CA
94143-2204
US

V. Phone/Fax

Practice location:
  • Phone: 415-514-4893
  • Fax:
Mailing address:
  • Phone: 817-881-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA180930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: