Provider Demographics
NPI:1851332852
Name:LEE, SUSAN EUN SIL (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:EUN SIL
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:EUN SIL
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-453-9789
Mailing Address - Fax:949-453-9235
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-453-9789
Practice Address - Fax:949-453-9235
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH38207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist