Provider Demographics
NPI:1407005697
Name:LEE, SANG (DMD)
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NE 87TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1930
Mailing Address - Country:US
Mailing Address - Phone:360-891-3020
Mailing Address - Fax:360-891-5992
Practice Address - Street 1:416 NE 87TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1930
Practice Address - Country:US
Practice Address - Phone:360-891-3020
Practice Address - Fax:360-891-5992
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603169761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice