Healthcare Provider Details

I. General information

NPI: 1942610381
Provider Name (Legal Business Name): SEJONG LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 AZALEA CT STE B
MYRTLE BEACH SC
29577-5765
US

IV. Provider business mailing address

7831 S DANISH PINE LN
COTTONWOOD HEIGHTS UT
84121-4100
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-0570
  • Fax:
Mailing address:
  • Phone: 972-822-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberMD92084
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: