Provider Demographics
NPI:1033112818
Name:LEE, SUNGCHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNGCHUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6622 N 91ST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:21410 N 19TH AVE
Practice Address - Street 2:SUITE 131
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2738
Practice Address - Country:US
Practice Address - Phone:623-780-1371
Practice Address - Fax:623-780-1393
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ32799207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ858889Medicaid
AZ858889Medicaid
I03669Medicare UPIN