Provider Demographics
NPI:1285296533
Name:LEE, SUNAE HYUN (PEDORTHIST)
Entity type:Individual
Prefix:
First Name:SUNAE
Middle Name:HYUN
Last Name:LEE
Suffix:
Gender:F
Credentials:PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 PLEASANT HILL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4153
Mailing Address - Country:US
Mailing Address - Phone:470-385-6020
Mailing Address - Fax:
Practice Address - Street 1:2550 PLEASANT HILL RD STE 106
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4153
Practice Address - Country:US
Practice Address - Phone:470-385-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-07
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPED4487224L00000X
GACPED4487332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist