MEDICARE: DR. SANG GEUN LEE DMD

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	1223G0001X	General Practice Dentistry	7559	NV

General Provider Information

NPI Number	:	1982373346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANG GEUN LEE DMD

Provider Business Mailing Address
First Line	:	125 E REGENA AVE UNIT 240
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3665
Country	:	US
Telephone Number	:	702-480-4978
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W CHARLESTON BLVD # A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2335
Country	:	US
Telephone Number	:	702-774-2400
Fax Number	:

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

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	08/28/2023

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