Provider Demographics
NPI:1952852196
Name:LEE, SUNG MIN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUNG MIN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SOUTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5641
Mailing Address - Country:US
Mailing Address - Phone:303-722-8987
Mailing Address - Fax:303-722-2935
Practice Address - Street 1:1001 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5641
Practice Address - Country:US
Practice Address - Phone:303-722-8987
Practice Address - Fax:303-722-2935
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006467363A00000X
PAMA058420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant