Provider Demographics
NPI:1679535983
Name:LEE, SUNG W (MD)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:W
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 1:7610 CARROLL AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912
Mailing Address - Country:US
Mailing Address - Phone:301-891-6574
Mailing Address - Fax:301-891-6222
Practice Address - Street 1:7610 CARROLL AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912
Practice Address - Country:US
Practice Address - Phone:301-891-6574
Practice Address - Fax:301-891-6222
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037960207RC0000X
MDD37960207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH830OtherBCBS OF MD GROUP NUMBER
DC0015OtherBCBS OF DC INDIVIDUAL #
MD53533702OtherBCBS OF MD INDIVIDUAL #
DC4787OtherBCBS OF DC GROUP NUMBER
MD883460101Medicaid
DC012846C23Medicare PIN
MD883460101Medicaid
DC1679535983Medicare PIN
MDH830OtherBCBS OF MD GROUP NUMBER
DC0015OtherBCBS OF DC INDIVIDUAL #
DC1912021619Medicare PIN