Provider Demographics
NPI:1801256243
Name:LEE, SANG SEA (NP)
Entity type:Individual
Prefix:MR
First Name:SANG SEA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 W 300 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-5397
Mailing Address - Country:US
Mailing Address - Phone:801-599-1001
Mailing Address - Fax:
Practice Address - Street 1:548 W 300 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5397
Practice Address - Country:US
Practice Address - Phone:801-599-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7070814-1201171100000X
CA95027428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171100000XOther Service ProvidersAcupuncturist