Healthcare Provider Details

I. General information

NPI: 1518955160
Provider Name (Legal Business Name): SANG-GIL LEE, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAWTHORNE PL SUITE 105
BOSTON MA
02114-2333
US

IV. Provider business mailing address

PO BOX 86
HINGHAM MA
02043-0086
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-1344
  • Fax: 617-643-2233
Mailing address:
  • Phone: 781-749-9071
  • Fax: 781-749-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number154629
License Number StateMA

VIII. Authorized Official

Name: SANG-GIL LEE
Title or Position: OWNER
Credential: M.D.
Phone: 617-726-1344