Basic Information
Provider Information
NPI: 1013046911
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: YUKFUNG
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 60000
Address2: FILE NO. 74010
City: SAN FRANCISCO
State: CA
PostalCode: 941600001
CountryCode: US
TelephoneNumber: 6503214121
FaxNumber:  
Practice Location
Address1: 795 EL CAMINO REAL
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943012302
CountryCode: US
TelephoneNumber: 6503214121
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 09/10/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XPA19018CAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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