Provider Demographics
NPI:1457340671
Name:LEE, SUO YI (MD)
Entity type:Individual
Prefix:DR
First Name:SUO
Middle Name:YI
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DORCHESTER AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5615
Mailing Address - Country:US
Mailing Address - Phone:617-296-0456
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0909
Practice Address - Country:US
Practice Address - Phone:617-296-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2375354OtherAETNA/US HEALTHCARE
210590104OtherUNITED HEALTHCARE OF NE
MA000000020208OtherBOSTON HEALTH NET
MA0103721Medicaid
MA69836OtherHARVARD PILGRIM HEALTH CA
203541OtherTUFTS ASSOCIATED HEALTH P
MA0024439OtherNEIGHBORHOOD HEALTH PLAN
J22611OtherBLUE CROSS/BLUE SHIELD
B10476201OtherCIGNA HEALTHCARE
203541OtherTUFTS ASSOCIATED HEALTH P
MAH23376Medicare UPIN