Provider Demographics
NPI:1528028941
Name:AHN-LEE, SANDRA SUNGMEE (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:SUNGMEE
Last Name:AHN-LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 E MAIN ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706
Mailing Address - Country:US
Mailing Address - Phone:631-665-1330
Mailing Address - Fax:631-665-1363
Practice Address - Street 1:180 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706
Practice Address - Country:US
Practice Address - Phone:631-665-3918
Practice Address - Fax:631-665-1818
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01332750Medicaid
NY01332750Medicaid
58K251Medicare ID - Type Unspecified