Basic Information
Provider Information
NPI: 1538494463
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: CINDY
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1520 STOCKTON ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941333354
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1520 STOCKTON ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941333354
CountryCode: US
TelephoneNumber: 4153919686
FaxNumber: 4153981745
Other Information
ProviderEnumerationDate: 10/09/2009
LastUpdateDate: 02/03/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207V00000X20A11450CAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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