Provider Demographics
NPI:1821191339
Name:LEE, SANG KYUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG KYUNE
Middle Name:
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 1:401 N EWING ST.
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3372
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8939
Practice Address - Street 1:1955 LANCASTER NEWARK RD NE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1058
Practice Address - Country:US
Practice Address - Phone:740-689-2820
Practice Address - Fax:740-689-2830
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129925207Q00000X
IN01072683A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201164410Medicaid
IN000000824286OtherANTHEM
IN259370007Medicare PIN