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General NPI Number Information
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NPI Number | 1780694356
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Entity Type | Individual
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Provider Name | SANG DAE LEE DPM
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Gender | Male
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 2095 N WATERMAN AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4834
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Country | US
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Telephone | 909-882-3800
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Fax | 909-882-3380
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Provider Business Mailing Address
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Address Line | 467 REDTAIL DR
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City | BREA
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State | CA
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Zip | 92823-1040
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Country | US
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Telephone | 909-882-3800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4416
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License Number State | CA
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