Healthcare Provider Details

I. General information

NPI: 1477647675
Provider Name (Legal Business Name): KYUNG R. LEE, MD & KESOOK LEE, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KESOOK K LEE
Title or Position: SECRETARY
Credential: M.D.
Phone: 415-406-1333