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1215932033

NPI Code Detail

MEDICARE: DR. MICHAEL SUKMIN LEE M.D.

MEDICARE: DR. MICHAEL SUKMIN LEE M.D.

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	207W00000X	Ophthalmology Physician	MD00044319	WA
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD00044319	WA
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	MD25478	OR
4	207W00000X	Ophthalmology Physician	MD25478	OR

General Provider Information

NPI Number	:	1215932033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SUKMIN LEE M.D.

Provider Business Mailing Address
First Line	:	4225 NE ST JAMES RD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-2148
Country	:	US
Telephone Number	:	503-274-2121
Fax Number	:	866-843-7990

Provider Business Practice Location Address
First Line	:	5440 SW WESTGATE DR STE 217
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97221-2421
Country	:	US
Telephone Number	:	503-274-2121
Fax Number	:	866-843-7990

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	10/01/2024

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Directions to “ DR. MICHAEL SUKMIN LEE M.D.” Practice Location

Language	Start Address	Practice Location

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