Basic Information
Provider Information
NPI: 1497701171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEE
FirstName: SEA
MiddleName: HYIENG
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5424 GRAND BLVD
Address2:  
City: NEW PORT RICHEY
State: FL
PostalCode: 34652
CountryCode: US
TelephoneNumber: 7278451736
FaxNumber: 7278490759
Practice Location
Address1: 14000 FIVAY RD
Address2:  
City: HUDSON
State: FL
PostalCode: 34667
CountryCode: US
TelephoneNumber: 7278615155
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XME73472FLY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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