Provider Demographics
NPI:1649270810
Name:LEE, SANG-GIL (MD)
Entity type:Individual
Prefix:
First Name:SANG-GIL
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0086
Mailing Address - Country:US
Mailing Address - Phone:781-749-9071
Mailing Address - Fax:781-749-2133
Practice Address - Street 1:1 HAWTHORNE PL
Practice Address - Street 2:SUITE 105
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2333
Practice Address - Country:US
Practice Address - Phone:617-726-1344
Practice Address - Fax:617-643-2233
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154629207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3168581Medicaid
MAG32013Medicare UPIN
MA3168581Medicaid