Provider Demographics
NPI:1194917799
Name:LEE, AMELIA HYE-SUK (DPM)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:HYE-SUK
Last Name:LEE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:HYE-SUK
Other - Middle Name:
Other - Last Name:YI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4092 BLACKFIN AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3204
Mailing Address - Country:US
Mailing Address - Phone:949-278-5201
Mailing Address - Fax:
Practice Address - Street 1:4092 BLACKFIN AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3204
Practice Address - Country:US
Practice Address - Phone:949-278-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3490213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist