MEDICARE: DR. DAVID H LEE DDS, MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	54536	CA

General Provider Information

NPI Number	:	1558401018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID H LEE DDS, MSD

Provider Business Mailing Address
First Line	:	2402 CALIFORNIA ST APT 207
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2602
Country	:	US
Telephone Number	:	310-780-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 FARMERS LN
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-6707
Country	:	US
Telephone Number	:	707-542-5200
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/01/2011

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