Provider Demographics
NPI:1205952298
Name:LEE, SAE EUN (OMD)
Entity type:Individual
Prefix:DR
First Name:SAE
Middle Name:EUN
Last Name:LEE
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1736
Mailing Address - Country:US
Mailing Address - Phone:702-386-2828
Mailing Address - Fax:702-386-2831
Practice Address - Street 1:1223 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1736
Practice Address - Country:US
Practice Address - Phone:702-386-2828
Practice Address - Fax:702-386-2831
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist