Healthcare Provider Details

I. General information

NPI: 1003998030
Provider Name (Legal Business Name): PETER L LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 FUNSTON AVE
SAN FRANCISCO CA
94116-1340
US

IV. Provider business mailing address

3801 SACRAMENTO ST ROOM 325
SAN FRANCISCO CA
94118-1625
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-5549
  • Fax:
Mailing address:
  • Phone: 415-600-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG37381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: