Provider Demographics
NPI:1225721004
Name:LEE, SANG HUN
Entity type:Individual
Prefix:MR
First Name:SANG HUN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EXPO PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4230
Mailing Address - Country:US
Mailing Address - Phone:916-698-9145
Mailing Address - Fax:
Practice Address - Street 1:1400 EXPO PARKWAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815
Practice Address - Country:US
Practice Address - Phone:916-437-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-30
Last Update Date:2024-11-15
Deactivation Date:2024-01-02
Deactivation Code:
Reactivation Date:2024-06-12
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA95031203363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program