Provider Demographics
NPI:1376794784
Name:LEE, MEE SUK (MA,RD)
Entity Type:Individual
Prefix:MS
First Name:MEE
Middle Name:SUK
Last Name:LEE
Suffix:
Gender:F
Credentials:MA,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S BERENDO ST APT 309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5745
Mailing Address - Country:US
Mailing Address - Phone:213-384-3304
Mailing Address - Fax:
Practice Address - Street 1:141 S BERENDO ST APT 309
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5745
Practice Address - Country:US
Practice Address - Phone:213-384-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL925557133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered