Provider Demographics
NPI:1255425773
Name:LEE, KESOOK K (MD)
Entity type:Individual
Prefix:
First Name:KESOOK
Middle Name:K
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46303208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46303OtherMEDICAL LICENSE
CAA46303OtherMEDICAL LICENSE
CAF12853Medicare UPIN