Provider Demographics
NPI:1598266355
Name:LEE, HYE SUN
Entity Type:Individual
Prefix:
First Name:HYE SUN
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 1:6102 LAKEFIELD PL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2353
Mailing Address - Country:US
Mailing Address - Phone:229-560-3137
Mailing Address - Fax:
Practice Address - Street 1:4855 RIVER GREEN PKWY STE 140
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8333
Practice Address - Country:US
Practice Address - Phone:678-417-0077
Practice Address - Fax:678-417-0337
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily