Provider Demographics
NPI:1770655003
Name:LEE, SANG-MIN JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:SANG-MIN
Middle Name:JUSTIN
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3028
Mailing Address - Country:US
Mailing Address - Phone:888-988-2800
Mailing Address - Fax:
Practice Address - Street 1:441 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3028
Practice Address - Country:US
Practice Address - Phone:888-988-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89250208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology