Provider Demographics
NPI:1891884078
Name:LEE, SUZANNE YOOKYUNG (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:YOOKYUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 45TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2938
Mailing Address - Country:US
Mailing Address - Phone:219-922-6226
Mailing Address - Fax:
Practice Address - Street 1:759 45TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2938
Practice Address - Country:US
Practice Address - Phone:219-922-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034128207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100212660 AMedicaid
IN000000086700OtherANTHEM
INM400056602Medicare PIN
IND13485Medicare UPIN
IN100212660 AMedicaid
IN000000086700OtherANTHEM