Provider Demographics
NPI:1831188341
Name:LEE, SANDY Y (MD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:Y
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16500 VENTURA BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2011
Mailing Address - Country:US
Mailing Address - Phone:818-788-9333
Mailing Address - Fax:818-788-9273
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-788-9333
Practice Address - Fax:818-788-9273
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67422207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A674220Medicaid
CAH36377Medicare UPIN
CAWA67422CMedicare ID - Type Unspecified