Basic Information
| Provider Information | |||||||||
| NPI: | 1255425773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | KESOOK | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 OCEAN AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941321645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154061333 | ||||||||
| FaxNumber: | 4154061337 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 OCEAN AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941321645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154061333 | ||||||||
| FaxNumber: | 4154061337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A46303 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | A46303 | 01 | CA | MEDICAL LICENSE | OTHER |