Individual
DR. SANGYOUNG LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
125 S NAPPANEE ST, ELKHART, IN 46514-1967
(574) 522-0516
(574) 294-1407
Mailing address
125 S NAPPANEE ST, ELKHART, IN 46514-1967
(574) 522-0516
(574) 294-1407
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9361
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000530461
UNITED CONCORDIA
IN
05
—
100327580A
—
IN
01
—
351864354
TAX ID
IN
Enumeration date
12/02/2006
Last updated
01/11/2017
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