Healthcare Provider Details

I. General information

NPI: 1316026842
Provider Name (Legal Business Name): EUNJOO LEE JUSTICE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 41ST AVE
SAN FRANCISCO CA
94116-1101
US

IV. Provider business mailing address

1380 HOWARD ST 5TH FLOOR
SAN FRANCISCO CA
94103-2638
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-7255
  • Fax: 415-753-0164
Mailing address:
  • Phone: 415-255-3699
  • Fax: 415-252-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA42018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: