Active NPI
Suk Ki Kathleen Lee, D.D.S.
- Endodontics
- Portland, OR
National Provider Identifier
1811017668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- D7421
- Practice address
- 1001 SW 5TH Ave
Suite 222
Portland, OR 97204-1147 - Phone
- (503) 222-5355
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | D7421 | OR | Primary |
Addresses
Primary practice location
1001 SW 5TH Ave
Suite 222
Portland, OR 97204-1147
Mailing address
1101 SE Tech Center Dr
Suite 195
Vancouver, WA 98683-5504
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 17, 2016 through Mar 17, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7421 | OR | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1811017668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 SE TECH CENTER DR",
"address_2": "SUITE 195",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986835504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 SW 5TH AVE",
"address_2": "SUITE 222",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972041147",
"telephone_number": "503-222-5355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SUK KI",
"middle_name": "KATHLEEN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "OR",
"license": "D7421",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.