Provider Demographics
NPI:1942231410
Name:LEE, SANG N (MD)
Entity Type:Individual
Prefix:DR
First Name:SANG
Middle Name:N
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8503 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4628
Mailing Address - Country:US
Mailing Address - Phone:703-698-7485
Mailing Address - Fax:703-698-9469
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-774-3731
Practice Address - Fax:703-776-2743
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2085R0001X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Not Answered2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD05974Medicare UPIN
VA058190Medicare ID - Type UnspecifiedMEDICARE PART B