Provider Demographics
NPI:1902842693
Name:LEE, SONG UN (MD)
Entity Type:Individual
Prefix:
First Name:SONG
Middle Name:UN
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 1:3795 MANSELL RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8247
Mailing Address - Country:US
Mailing Address - Phone:404-785-8540
Mailing Address - Fax:404-785-8574
Practice Address - Street 1:3795 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8247
Practice Address - Country:US
Practice Address - Phone:404-785-8540
Practice Address - Fax:404-785-8574
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics