Provider Demographics
NPI:1558189811
Name:LEE, BRIANA SU-YEON
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:SU-YEON
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7613 WYATT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5348
Mailing Address - Country:US
Mailing Address - Phone:580-919-5407
Mailing Address - Fax:
Practice Address - Street 1:7613 WYATT LAKE DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5348
Practice Address - Country:US
Practice Address - Phone:580-919-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program