Healthcare Provider Details

I. General information

NPI: 1629187729
Provider Name (Legal Business Name): SANDRA HYUN JU LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 CAPITAL MALL DR SW STE B
OLYMPIA WA
98502-8654
US

IV. Provider business mailing address

PO BOX 368
OLYMPIA WA
98507-0368
US

V. Phone/Fax

Practice location:
  • Phone: 360-528-8571
  • Fax: 360-528-8562
Mailing address:
  • Phone: 360-455-5144
  • Fax: 360-491-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61076513
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: