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General NPI Number Information
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NPI Number | 1720069891
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Entity Type | Organization
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Legal Business Name | NORTHERN CALIFORNIA RADIATION THERAPISTS & ONCOLOGISTS MEDICAL GROUP I
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 2333 BUCHANAN ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-1925
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Country | US
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Telephone | 209-342-2300
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Fax | 209-524-4240
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Provider Business Mailing Address
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Address Line | 450 GLASS LN STE C
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City | MODESTO
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State | CA
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Zip | 95356-9287
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Country | US
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Telephone | 209-342-2300
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Fax | 209-524-4240
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN W LEE
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Credential | MD
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Telephone | 209-342-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 102829
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License Number State | CA
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