MEDICARE: DR. SUSAN HAE KYUNG LEE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN011872	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124042049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN HAE KYUNG LEE DMD

Provider Business Mailing Address
First Line	:	3280 HOWELL MILL RD NW STE 121
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4107
Country	:	US
Telephone Number	:	404-355-8557
Fax Number	:	404-355-8321

Provider Business Practice Location Address
First Line	:	3280 HOWELL MILL RD NW STE 121
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4107
Country	:	US
Telephone Number	:	404-355-8557
Fax Number	:	404-355-8321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	09/18/2018

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