Provider Demographics
NPI:1922160183
Name:LEE, JOHN SUKWOO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SUKWOO
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 1:2363 NW FLANDERS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3409
Mailing Address - Country:US
Mailing Address - Phone:503-228-5432
Mailing Address - Fax:503-222-1377
Practice Address - Street 1:2363 NW FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3409
Practice Address - Country:US
Practice Address - Phone:503-228-5432
Practice Address - Fax:503-222-1377
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21988208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery