Provider Demographics
NPI:1053634832
Name:LEE, SANG MIN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:MIN
Last Name:LEE
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8808 CENTRE PARK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2126
Mailing Address - Country:US
Mailing Address - Phone:410-997-0987
Mailing Address - Fax:410-997-1250
Practice Address - Street 1:8808 CENTRE PARK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2126
Practice Address - Country:US
Practice Address - Phone:410-997-0987
Practice Address - Fax:410-715-2280
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02139171100000X
MDS03614111N00000X
NJ25MZ00085000171100000X
NY011843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011843OtherLICENSE