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General NPI Number Information
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NPI Number | 1215932033
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Entity Type | Individual
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Provider Name | MICHAEL SUKMIN LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 5440 SW WESTGATE DR STE 217
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City | PORTLAND
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State | OR
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Zip | 97221-2421
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Country | US
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Telephone | 503-274-2121
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Fax | 866-843-7990
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Provider Business Mailing Address
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Address Line | 4225 NE ST JAMES RD
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City | VANCOUVER
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State | WA
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Zip | 98663-2148
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Country | US
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Telephone | 503-274-2121
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Fax | 866-843-7990
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD00044319
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | MD00044319
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | MD25478
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD25478
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License Number State | OR
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