Basic Information
| Provider Information | |||||||||
| NPI: | 1952852196 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SUNG MIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 SOUTHPARK DR | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801205641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037228987 | ||||||||
| FaxNumber: | 3037222935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 SOUTHPARK DR | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801205641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037228987 | ||||||||
| FaxNumber: | 3037222935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2016 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.0006467 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | MA058420 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.