Provider Demographics
NPI:1457445249
Name:LEE, CAROLINE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:JEAN
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:C JEANNE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1000 CAYUGA AVE
Mailing Address - Street 2:BALBOA TEEN HEALTH CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112
Mailing Address - Country:US
Mailing Address - Phone:415-469-4512
Mailing Address - Fax:415-469-4096
Practice Address - Street 1:1000 CAYUGA AVE
Practice Address - Street 2:BALBOA TEEN HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112
Practice Address - Country:US
Practice Address - Phone:415-469-4512
Practice Address - Fax:415-469-4096
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A868990OtherPPIN
00A868990OtherPPIN