=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275545345
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN D LEE DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1291 EAST HILLSDALE BLVD #100
-----------------------------------------------------
City | FOSTER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-574-4447
-----------------------------------------------------
Fax | 650-574-4041
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1291 EAST HILLSDALE BLVD #100
-----------------------------------------------------
City | FOSTER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-574-4447
-----------------------------------------------------
Fax | 650-574-4041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN D LEE
-----------------------------------------------------
Credential | DDS MSD
-----------------------------------------------------
Telephone | 650-574-4447
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D-19108
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | D-19108
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------