Provider Demographics
NPI:1174525851
Name:SCHWARTZ, LEE KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:KENNETH
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:711 VAN NESS AVENUE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3285
Mailing Address - Country:US
Mailing Address - Phone:415-921-7555
Mailing Address - Fax:415-921-1475
Practice Address - Street 1:711 VAN NESS AVE STE 310
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3285
Practice Address - Country:US
Practice Address - Phone:415-921-7555
Practice Address - Fax:415-921-1475
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG292190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G292190Medicare PIN
CA00G292194Medicare PIN
CAA43985Medicare UPIN
CA00G292193Medicare PIN