Provider Demographics
NPI:1477647675
Name:KYUNG R. LEE, MD & KESOOK LEE, MD
Entity Type:Organization
Organization Name:KYUNG R. LEE, MD & KESOOK LEE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KESOOK
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-406-1333
Mailing Address - Street 1:2555 OCEAN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1645
Mailing Address - Country:US
Mailing Address - Phone:415-406-1333
Mailing Address - Fax:415-406-1337
Practice Address - Street 1:2555 OCEAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1645
Practice Address - Country:US
Practice Address - Phone:415-406-1333
Practice Address - Fax:415-406-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00110ZMedicare ID - Type Unspecified