Provider Demographics
NPI:1619137932
Name:LEE, SOOKWOOK (MD)
Entity Type:Individual
Prefix:
First Name:SOOKWOOK
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOOKWOOK
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12 WEST 32ND ST. 2FL.
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-574-4994
Mailing Address - Fax:914-517-1320
Practice Address - Street 1:12 W 32ND ST
Practice Address - Street 2:FL 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-0291
Practice Address - Country:US
Practice Address - Phone:212-574-4994
Practice Address - Fax:917-517-1320
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091767207Q00000X
NY249997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine