Provider Demographics
NPI:1235682717
Name:LEE, SUN MYOUNG
Entity Type:Individual
Prefix:
First Name:SUN MYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 MARKET ST
Mailing Address - Street 2:UNIT 1114
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1491
Mailing Address - Country:US
Mailing Address - Phone:201-661-3706
Mailing Address - Fax:
Practice Address - Street 1:2000 MARKET ST
Practice Address - Street 2:BSA2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3231
Practice Address - Country:US
Practice Address - Phone:215-564-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist