Provider Demographics
NPI:1770716524
Name:LEE, SOO PAIK (MD)
Entity type:Individual
Prefix:
First Name:SOO
Middle Name:PAIK
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 1:5475 POPLAR AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3730
Mailing Address - Country:US
Mailing Address - Phone:901-254-8040
Mailing Address - Fax:
Practice Address - Street 1:5475 POPLAR AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3730
Practice Address - Country:US
Practice Address - Phone:901-254-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000048922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine