1366757486 NPI number — DR. ANDREW SUNGCHURL LEE M.D.

Table of content: DR. ANDREW SUNGCHURL LEE M.D. (NPI 1366757486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366757486 NPI number — DR. ANDREW SUNGCHURL LEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
ANDREW
Provider Middle Name:
SUNGCHURL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366757486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
372 RIVER OAKS BLVD W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKVILLE
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L6H 5E7
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 SSANGBONGRO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YEOSU
Provider Business Practice Location Address State Name:
JEONNAM
Provider Business Practice Location Address Postal Code:
555807
Provider Business Practice Location Address Country Code:
KR
Provider Business Practice Location Address Telephone Number:
821033197508
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  265694 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 265694 . This is a "NYSED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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