Provider Demographics
NPI:1215369384
Name:SANG H. LEE, D.O., P.C.
Entity Type:Organization
Organization Name:SANG H. LEE, D.O., P.C.
Other - Org Name:TLC WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-202-9355
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100113780EMedicaid
242421801Medicare PIN