Provider Demographics
NPI:1194748541
Name:SIMON LEE M D A PROFESSIONAL CORP
Entity type:Organization
Organization Name:SIMON LEE M D A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:KWANMIN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-837-0888
Mailing Address - Street 1:950 STOCKTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1619
Mailing Address - Country:US
Mailing Address - Phone:415-837-0888
Mailing Address - Fax:415-837-1328
Practice Address - Street 1:950 STOCKTON ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1619
Practice Address - Country:US
Practice Address - Phone:415-837-0888
Practice Address - Fax:415-837-1328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G831960Medicaid
CAZZZ04879ZMedicare PIN
CA00G831960Medicaid