MEDICARE: GEORGE LEE

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	163WC1500X	Community Health Registered Nurse	95121705	CA

General Provider Information

NPI Number	:	1669986451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE LEE

Provider Business Mailing Address
First Line	:	2460 22ND ST # ST94
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 22ND ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2815
Country	:	US
Telephone Number	:	415-206-8524
Fax Number	:

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

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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Directions to “ GEORGE LEE ” Practice Location

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