Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 4301105849 | MI |
N | 207RC0000X | Internist - Cardiovascular Disease | 4301105849 | MI |
NPI | 1013050764 |
---|---|
Provider Name | Sangjin Lee |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 09/09/2021 |