Provider Demographics
NPI:1033687272
Name:LEE, BRUCE SANGHO
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:SANGHO
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8749
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-5749
Mailing Address - Country:US
Mailing Address - Phone:714-323-9603
Mailing Address - Fax:
Practice Address - Street 1:534 CARDINAL ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92823-1005
Practice Address - Country:US
Practice Address - Phone:714-323-9603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies