Provider Demographics
NPI:1114936945
Name:LEE, SANG JUNG (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:JUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 S. HARVARD BL.
Mailing Address - Street 2:120
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004
Mailing Address - Country:US
Mailing Address - Phone:213-384-6323
Mailing Address - Fax:213-384-6340
Practice Address - Street 1:266 S. HARVARD BL.
Practice Address - Street 2:120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004
Practice Address - Country:US
Practice Address - Phone:213-384-6323
Practice Address - Fax:213-384-6340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46373183500000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility