Healthcare Provider Details

I. General information

NPI: 1265937049
Provider Name (Legal Business Name): CHRISTOPHER DEREK LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE # M391
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

1101 N MAIN ST APT 617
LOS ANGELES CA
90012-4762
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1537
  • Fax:
Mailing address:
  • Phone: 732-619-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA165127
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA165127
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA165127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: