Provider Demographics
NPI:1700927605
Name:LEE, SANG JU
Entity Type:Individual
Prefix:
First Name:SANG
Middle Name:JU
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SANG
Other - Middle Name:JU
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2732 WEST OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006
Mailing Address - Country:US
Mailing Address - Phone:213-382-6391
Mailing Address - Fax:
Practice Address - Street 1:2732 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2633
Practice Address - Country:US
Practice Address - Phone:213-382-6391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH35138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist