Provider Demographics
NPI:1699152454
Name:BANIK, GRACE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:LEE
Last Name:BANIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:MYUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 16TH ST RM 5310
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2545
Mailing Address - Country:US
Mailing Address - Phone:415-353-2757
Mailing Address - Fax:415-476-5369
Practice Address - Street 1:550 16TH ST RM 5310
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2545
Practice Address - Country:US
Practice Address - Phone:415-353-2757
Practice Address - Fax:415-476-5369
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA182376207YP0228X
PAMD473043207Y00000X
PAMT220064207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology