Healthcare Provider Details

I. General information

NPI: 1558127605
Provider Name (Legal Business Name): HANNAH LEE DPM PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S SAN MATEO DR STE 302
SAN MATEO CA
94401-3844
US

IV. Provider business mailing address

101 S SAN MATEO DR STE 302
SAN MATEO CA
94401-3844
US

V. Phone/Fax

Practice location:
  • Phone: 650-484-0700
  • Fax:
Mailing address:
  • Phone: 650-484-0700
  • Fax: 650-484-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: HANNAH H LEE
Title or Position: PRESIDENT
Credential: DPM
Phone: 650-484-0700