MEDICARE: ANNE R LEE DDS

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	1223P0221X	Pediatric Dentistry	DDS48312	CA

General Provider Information

NPI Number	:	1639272834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE R LEE DDS

Provider Business Mailing Address
First Line	:	1475 HUNTINGTON AVE
Second Line	:	STE 150
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5990
Country	:	US
Telephone Number	:	560-873-5212
Fax Number	:	650-873-8877

Provider Business Practice Location Address
First Line	:	1475 HUNTINGTON AVE
Second Line	:	STE 150
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5990
Country	:	US
Telephone Number	:	560-873-5212
Fax Number	:	650-873-8877

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/02/2016

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