Provider Demographics
NPI:1477957728
Name:LEE, SIEUN
Entity Type:Individual
Prefix:
First Name:SIEUN
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:SEOCHOGU SHINBANPORO 270
Mailing Address - Street 2:XI APT 139 DONG 1401 HO
Mailing Address - City:SEOUL
Mailing Address - State:SEOUL
Mailing Address - Zip Code:137930
Mailing Address - Country:KR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 COMBAT SUPPORT HOSPITAL UNIT 15244
Practice Address - Street 2:BRIAN ALLGOOD COMMUNITY HOSPITAL. DEPT OF PHARMACY
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:315-737-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65321183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist