Provider Demographics
NPI:1578689071
Name:LEE, SANG HYO (DC)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:HYO
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1834
Mailing Address - Country:US
Mailing Address - Phone:443-446-5240
Mailing Address - Fax:714-636-2481
Practice Address - Street 1:3916 HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1834
Practice Address - Country:US
Practice Address - Phone:443-446-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30443111N00000X
MDS04087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor