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General NPI Number Information
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NPI Number | 1033564935
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Entity Type | Individual
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Provider Name | DR. SU-MIN LEE
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Gender | Female
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 04/28/2016
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Provider Practice Location Address
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Address Line | 240 S 40TH ST SCHOOL OF DENTAL MEDICINE, DEP. OF ENDODONTICS
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City | PHILADELPHIA
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State | PA
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Zip | 19104-6030
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Country | US
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Telephone | 215-898-4927
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Fax |
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Provider Business Mailing Address
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Address Line | 1229 CHESTNUT ST APT 1214
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4140
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Country | US
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Telephone | 267-206-8698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | RFD000014
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 64396
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License Number State | CA
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