Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 3864 | OK |
Y | 207PE0004X | Emergency Medical Services | 3864 | OK |
NPI | 1003802182 |
---|---|
Provider Name | Sang H. Lee |
First Address | Bethany, OK 73008-4961 |
Second Address | Bethany, OK 73008-4961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100113780E | (05) | OK |
H45005 | (02) |