Provider Demographics
NPI:1568065878
Name:KIM LEE, SUN YOUNG
Entity Type:Individual
Prefix:MRS
First Name:SUN YOUNG
Middle Name:
Last Name:KIM 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 1:11625 JONES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-2539
Mailing Address - Country:US
Mailing Address - Phone:770-752-4642
Mailing Address - Fax:770-752-7692
Practice Address - Street 1:11625 JONES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-2539
Practice Address - Country:US
Practice Address - Phone:770-752-4642
Practice Address - Fax:770-752-7692
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021140183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist