Provider Demographics
NPI:1497773717
Name:LEE, SUNG AH (DO)
Entity Type:Individual
Prefix:
First Name:SUNG AH
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 W WOOD ST
Mailing Address - Street 2:#302
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7813
Mailing Address - Country:US
Mailing Address - Phone:847-682-5920
Mailing Address - Fax:
Practice Address - Street 1:15 SALT CREEK LN
Practice Address - Street 2:SUITE 111
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-2926
Practice Address - Country:US
Practice Address - Phone:630-371-0133
Practice Address - Fax:630-371-0138
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9259207R00000X
IL036118466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR00621Medicare PIN
ILR00620Medicare PIN