Provider Demographics
NPI:1659379725
Name:LEE, MICHAEL SUNGHOON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SUNGHOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2982
Mailing Address - Country:US
Mailing Address - Phone:631-265-5050
Mailing Address - Fax:631-265-3304
Practice Address - Street 1:260 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 214
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2982
Practice Address - Country:US
Practice Address - Phone:631-265-5050
Practice Address - Fax:631-265-3304
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177160-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01358727Medicaid
NY01358727Medicaid
NYF26415Medicare UPIN