=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134940943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DING DING KELLY LEE, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2024
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 490 POST ST STE 1112
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-1302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-233-6772
-----------------------------------------------------
Fax | 415-781-5406
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 15TH AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94116-1315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-501-4798
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DING DING KELLY LEE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-233-6772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------