Provider Demographics
NPI:1770700908
Name:LEE, JENNIFER J (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CLAY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1568
Mailing Address - Country:US
Mailing Address - Phone:415-982-9877
Mailing Address - Fax:
Practice Address - Street 1:929 CLAY ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1568
Practice Address - Country:US
Practice Address - Phone:415-982-9877
Practice Address - Fax:415-982-5523
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120644207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology