Active NPI
John Sukwoo Lee, MD
- Plastic Surgery Physician
- Portland, OR
National Provider Identifier
1922160183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- MD21988
- Practice address
- 2363 NW Flanders St
Portland, OR 97210-3409 - Phone
- (503) 228-5432
- Fax
- (503) 222-1377
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | MD21988 | OR | Primary |
Addresses
Primary practice location
2363 NW Flanders St
Portland, OR 97210-3409
Mailing address
2363 NW Flanders St
Portland, OR 97210-3409
Phone (503) 228-5432
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120507000388 | OR | Practitioner - Plastic and Reconstructive Surgery | 4284896333 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21988 | OR | MD | Point of Service |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922160183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2363 NW FLANDERS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103409",
"telephone_number": "503-228-5432",
"fax_number": "503-222-1377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2363 NW FLANDERS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972103409",
"telephone_number": "503-228-5432",
"fax_number": "503-222-1377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "JOHN",
"middle_name": "SUKWOO",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "OR",
"license": "MD21988",
"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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.