MEDICARE: CAROL K LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G062717	CA

General Provider Information

NPI Number	:	1063504298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL K LEE M.D.

Provider Business Mailing Address
First Line	:	1518 NORIEGA ST
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4434
Country	:	US
Telephone Number	:	415-566-7556
Fax Number	:	415-566-8486

Provider Business Practice Location Address
First Line	:	1518 NORIEGA ST
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4434
Country	:	US
Telephone Number	:	415-566-7556
Fax Number	:	415-566-8486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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