Healthcare Provider Details

I. General information

NPI: 1801256243
Provider Name (Legal Business Name): SANG SEA LEE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2016
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 W 300 S
OREM UT
84058-5397
US

IV. Provider business mailing address

548 W 300 S
OREM UT
84058-5397
US

V. Phone/Fax

Practice location:
  • Phone: 801-599-1001
  • Fax:
Mailing address:
  • Phone: 801-599-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number7070814-1201
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95027428
License Number StateCA

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: