Basic Information
Provider Information
NPI: 1497792576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: CHUL
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 47159
Address2:  
City: PLYMOUTH
State: MN
PostalCode: 554470159
CountryCode: US
TelephoneNumber: 7635593779
FaxNumber: 7634503986
Practice Location
Address1: 201 E NICOLLET BLVD
Address2:  
City: BURNSVILLE
State: MN
PostalCode: 553375714
CountryCode: US
TelephoneNumber: 9528922080
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X25791MNY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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