Provider Demographics
NPI:1881797744
Name:LEE, SANG KI (MD)
Entity type:Individual
Prefix:DR
First Name:SANG
Middle Name:KI
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 1:5150 GRAVES AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5004
Mailing Address - Country:US
Mailing Address - Phone:408-973-1313
Mailing Address - Fax:
Practice Address - Street 1:5150 GRAVES AVE STE 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5004
Practice Address - Country:US
Practice Address - Phone:408-973-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4003017Medicaid
CAA28532Medicare UPIN
CA4003017Medicaid