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General NPI Number Information
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NPI Number | 1528069507
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Entity Type | Individual
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Provider Name | SU-JU LEE MD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 234 GOODMAN AVENUE
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City | CINCINNATI
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State | OH
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Zip | 45219
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Country | US
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Telephone | 513-584-5335
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Fax | 513-584-3663
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Provider Business Mailing Address
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Address Line | PO BOX 636256 CENTRAL CREDENTIALING
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City | CINCINNATI
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State | OH
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Zip | 45263-6256
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Country | US
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Telephone | 513-245-3107
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Fax | 513-585-5511
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35058343L
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License Number State | OH
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