=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093106569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROL K. LEE, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2015
-----------------------------------------------------
Last Update Date | 02/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1518 NORIEGA ST STE 200
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-4434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-566-7556
-----------------------------------------------------
Fax | 415-566-8486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1518 NORIEGA ST STE 200
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94122-4434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-566-7556
-----------------------------------------------------
Fax | 415-566-8486
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRICIAN
-----------------------------------------------------
Name | CAROL K LEE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 415-566-7556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | G62717
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------