Provider Demographics
NPI:1013305689
Name:MASON Y. LEE, DDS, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:MASON Y. LEE, DDS, A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:415-472-5040
Mailing Address - Street 1:750 LAS GALLINAS AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3432
Mailing Address - Country:US
Mailing Address - Phone:415-472-5040
Mailing Address - Fax:415-472-5043
Practice Address - Street 1:750 LAS GALLINAS AVE STE 207
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3432
Practice Address - Country:US
Practice Address - Phone:415-472-5040
Practice Address - Fax:415-472-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42929261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery