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Individual

SANG O LEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
804 KENYON ROAD, SUITE A, FORT DODGE, IA 50501-5742
(515) 574-6120
(515) 574-6135
Mailing address
804 KENYON ROAD, SUITE A, FORT DODGE, IA 50501-5742
(515) 574-6120
(515) 574-6135

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
21456
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0159806
IA
01
10198
BLUE CROSS BLUE SHIELD
IA
Enumeration date
04/14/2006
Last updated
02/20/2012
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