Provider Demographics
NPI:1992803449
Name:LEE, JENNIFER SUNGMIN (CMD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:SUNGMIN
Last Name:LEE
Suffix:
Gender:F
Credentials:CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19318 RICHMOND BEACH DR NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2945
Mailing Address - Country:US
Mailing Address - Phone:206-542-7020
Mailing Address - Fax:
Practice Address - Street 1:19318 RICHMOND BEACH DR NW
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2945
Practice Address - Country:US
Practice Address - Phone:206-542-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14737232471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy