Basic Information
| Provider Information | |||||||||
| NPI: | 1477647675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KYUNG R. LEE, MD & KESOOK LEE, MD | ||||||||
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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: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | KESOOK | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4154061333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.