Healthcare Provider Details

I. General information

NPI: 1174525851
Provider Name (Legal Business Name): LEE KENNETH SCHWARTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 VAN NESS AVE STE 310
SAN FRANCISCO CA
94102-3285
US

IV. Provider business mailing address

711 VAN NESS AVENUE SUITE 310
SAN FRANCISCO CA
94115-3285
US

V. Phone/Fax

Practice location:
  • Phone: 415-921-7555
  • Fax: 415-921-1475
Mailing address:
  • Phone: 415-921-7555
  • Fax: 415-921-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG292190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: