MEDICARE: SANG JU LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH35138	CA

General Provider Information

NPI Number	:	1700927605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANG JU LEE

Provider Business Mailing Address
First Line	:	2732 WEST OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006
Country	:	US
Telephone Number	:	213-382-6391
Fax Number	:

Provider Business Practice Location Address
First Line	:	2732 W OLYMPIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-2633
Country	:	US
Telephone Number	:	213-382-6391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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Directions to “ SANG JU LEE ” Practice Location

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