Provider Demographics
NPI:1932882495
Name:NG, SOPHIE LEE (PA-S)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:LEE
Last Name:NG
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2592 ASSOCIATED RD APT 11
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4206
Mailing Address - Country:US
Mailing Address - Phone:206-788-5454
Mailing Address - Fax:
Practice Address - Street 1:4300 120TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1132
Practice Address - Country:US
Practice Address - Phone:206-788-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program