Provider Demographics
NPI:1093746703
Name:LEE, KARL (MD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:333 GELLERT BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2621
Mailing Address - Country:US
Mailing Address - Phone:650-994-2377
Mailing Address - Fax:650-994-0401
Practice Address - Street 1:333 GELLERT BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2621
Practice Address - Country:US
Practice Address - Phone:650-994-2377
Practice Address - Fax:650-994-0401
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 77379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 03755Medicare UPIN