Provider Demographics
NPI:1396730149
Name:LEE, WING KWONG (MD)
Entity type:Individual
Prefix:
First Name:WING
Middle Name:KWONG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 STOCKTON ST
Mailing Address - Street 2:STE 203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1633
Mailing Address - Country:US
Mailing Address - Phone:415-788-1072
Mailing Address - Fax:415-788-1219
Practice Address - Street 1:950 STOCKTON ST
Practice Address - Street 2:STE 203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1633
Practice Address - Country:US
Practice Address - Phone:415-788-1072
Practice Address - Fax:415-788-1219
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32108207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321081Medicaid
00A321080Medicare ID - Type Unspecified
CA00A321081Medicaid