Provider Demographics
NPI:1003802182
Name:LEE, SANG H (DO)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 NW 23RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4961
Mailing Address - Country:US
Mailing Address - Phone:405-241-7745
Mailing Address - Fax:
Practice Address - Street 1:7900 NW 23RD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4961
Practice Address - Country:US
Practice Address - Phone:405-241-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3864207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113780EMedicaid
OK100113780EMedicaid
OK242421801Medicare ID - Type Unspecified