Provider Demographics
NPI:1366757486
Name:LEE, ANDREW SUNGCHURL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SUNGCHURL
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 1:95 CHASEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1821
Mailing Address - Country:US
Mailing Address - Phone:646-384-2486
Mailing Address - Fax:
Practice Address - Street 1:95 CHASEWOOD LN
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1821
Practice Address - Country:US
Practice Address - Phone:646-384-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265694207X00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC167303OtherPHYSICIAN AND SURGEON C
NY265694OtherNYSED