Organization Active NPI

Lee Dermatology, P.C.

  • Dermatology Physician
  • San Francisco, CA
National Provider Identifier
1609215482
Registry record updated Jun 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A120644 Issued in CA
Legal business name
LEE DERMATOLOGY, P.C.
Practice address
929 Clay St Ste 105
San Francisco, CA 94108-1568
Phone
(415) 982-9877
Fax
(415) 982-5523
NPI assigned
Jun 14, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer Jin Lee, M.D.NPI 1770700908
Title
Physician
Phone
(415) 982-9877

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X A120644 CA Primary

Addresses

Primary practice location

929 Clay St Ste 105
San Francisco, CA 94108-1568

Mailing address

929 Clay St Ste 105
San Francisco, CA 94108-1568
Phone (415) 982-9877

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140521001359 CA Part B Supplier - Clinic/Group Practice 1456574318 Receives reassigned benefits from 1 practitioner
Practice locations: San Francisco, CA

National Provider Directory

National Provider Directory
Tax ID family
Lee Dermatology PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

929 Clay St
Ste 105
San Francisco, CA 94108
Phone (415) 982-9877

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371168000000",
    "number": "1609215482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 CLAY ST STE 105",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941081568",
            "telephone_number": "415-982-9877",
            "fax_number": "415-982-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "929 CLAY ST STE 105",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941081568",
            "telephone_number": "415-982-9877",
            "fax_number": "415-982-5523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEE DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-14",
        "last_updated": "2013-06-14",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "JIN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "415-982-9877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A120644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.