Provider Demographics
NPI:1669851556
Name:LEE, MICHAEL JOO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOO
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 KANSAS ST UNIT 558
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2218
Mailing Address - Country:US
Mailing Address - Phone:617-331-6042
Mailing Address - Fax:
Practice Address - Street 1:735 LARKIN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7149
Practice Address - Country:US
Practice Address - Phone:415-589-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-25
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024701223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics