Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 32799 | AZ |
NPI | 1033112818 |
---|---|
Provider Name | Dr. Sungchun Lee |
First Address | Glendale, AZ 85305-2569 |
Second Address | Phoenix, AZ 85027-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
858889 | (05) | AZ |
I03669 | (02) |