MEDICARE: CHARLES K. LEE, MD, INC.

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	A82918	CA
2	208200000X	Plastic Surgery Physician	A82918	CA

General Provider Information

NPI Number	:	1689858094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES K. LEE, MD, INC.

Provider Business Mailing Address
First Line	:	1545 PINE ST
Second Line	:	UNIT 101
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4682
Country	:	US
Telephone Number	:	415-933-8330
Fax Number	:	415-933-8292

Provider Business Practice Location Address
First Line	:	1545 PINE ST.
Second Line	:	UNIT 101
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-1078
Country	:	US
Telephone Number	:	415-933-8330
Fax Number	:	415-933-8292

Authorized Official
Title or Position	:	PRESIDENT/ATTENDING SURGEON
Name	:	DR. CHARLES K. LEE
Credential	:	MD
Telephone Number	:	415-933-8330

Provider Enumeration Date	:	12/20/2007
Last Update Date	:	08/24/2021

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