Provider Demographics
NPI:1841324456
Name:LEE, SANDY O (MD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:O
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 1:24422 AVENIDA DE LA CARLOTA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3628
Mailing Address - Country:US
Mailing Address - Phone:949-599-2434
Mailing Address - Fax:949-599-2430
Practice Address - Street 1:4968 BOOTH CIR STE 106
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3370
Practice Address - Country:US
Practice Address - Phone:949-387-4900
Practice Address - Fax:949-387-4945
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA711527208000000X
CAA71522208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563950Medicaid