Provider Demographics
NPI:1710631759
Name:LEE, DUNSTAN T
Entity Type:Individual
Prefix:
First Name:DUNSTAN
Middle Name:T
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 SAINT FRANCIS BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2151
Mailing Address - Country:US
Mailing Address - Phone:650-438-2284
Mailing Address - Fax:
Practice Address - Street 1:1860 EL CAMINO REAL STE 420
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3117
Practice Address - Country:US
Practice Address - Phone:650-652-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist