Provider Demographics
NPI:1639251259
Name:IL SUNG LEE, M.D., P.A.
Entity Type:Organization
Organization Name:IL SUNG LEE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IL
Authorized Official - Middle Name:SUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-667-5298
Mailing Address - Street 1:123 ACTON CIR
Mailing Address - Street 2:UNIT A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1043
Mailing Address - Country:US
Mailing Address - Phone:828-667-5298
Mailing Address - Fax:828-667-4245
Practice Address - Street 1:123 ACTON CIR
Practice Address - Street 2:UNIT A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1043
Practice Address - Country:US
Practice Address - Phone:828-667-5298
Practice Address - Fax:828-667-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20155261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51514OtherBCBS
NC8951514Medicaid
C85290Medicare UPIN
NC8951514Medicaid