Healthcare Provider Details

I. General information

NPI: 1164163465
Provider Name (Legal Business Name): SUE WON LEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S GREEN VALLEY PKWY STE 140
HENDERSON NV
89052-0431
US

IV. Provider business mailing address

732 S 6TH ST # 7242
LAS VEGAS NV
89101-6948
US

V. Phone/Fax

Practice location:
  • Phone: 702-790-2701
  • Fax:
Mailing address:
  • Phone: 725-277-5594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO4059
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: