Healthcare Provider Details

I. General information

NPI: 1699933283
Provider Name (Legal Business Name): CECILIA SUNGMIN LEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 09/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 MID AMERICA PLZ DEPT OPTHALMOLOGY, STE 2500
SAINT LOUIS MO
63129-0002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-273-0020
  • Fax: 314-273-0033
Mailing address:
  • Phone: 314-273-0020
  • Fax: 314-273-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number2025039165
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: