Provider Demographics
NPI:1548443724
Name:LEE, IL SUNG (MD)
Entity type:Individual
Prefix:
First Name:IL SUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ACTON CIR
Mailing Address - Street 2:UNIT A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1043
Mailing Address - Country:US
Mailing Address - Phone:828-667-5298
Mailing Address - Fax:828-667-4245
Practice Address - Street 1:123 ACTON CIR
Practice Address - Street 2:UNIT A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1043
Practice Address - Country:US
Practice Address - Phone:828-667-5298
Practice Address - Fax:828-667-4245
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951514Medicaid