Provider Demographics
NPI:1245781657
Name:LEE, SANGEUN
Entity Type:Individual
Prefix:MS
First Name:SANGEUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:261 N MADISON AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4476
Mailing Address - Country:US
Mailing Address - Phone:626-204-2014
Mailing Address - Fax:
Practice Address - Street 1:261 N MADISON AVE
Practice Address - Street 2:APT 401
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4476
Practice Address - Country:US
Practice Address - Phone:626-204-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program