Provider Demographics
NPI:1215932033
Name:LEE, MICHAEL SUKMIN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SUKMIN
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 1:4225 NE ST JAMES RD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2148
Mailing Address - Country:US
Mailing Address - Phone:503-274-2121
Mailing Address - Fax:866-843-7990
Practice Address - Street 1:5440 SW WESTGATE DR STE 217
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-2421
Practice Address - Country:US
Practice Address - Phone:503-274-2121
Practice Address - Fax:866-843-7990
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044319207W00000X, 207WX0107X
ORMD25478207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH02374Medicare UPIN