MEDICARE: SUE 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	2084P0804X	Child & Adolescent Psychiatry Physician	A73481	CA

General Provider Information

NPI Number	:	1205986080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE LEE M.D.

Provider Business Mailing Address
First Line	:	1626A UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4507
Country	:	US
Telephone Number	:	415-928-1234
Fax Number	:	415-928-1222

Provider Business Practice Location Address
First Line	:	1626A UNION ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4507
Country	:	US
Telephone Number	:	415-928-1234
Fax Number	:	415-928-1222

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	02/11/2022

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