Provider Demographics
NPI:1306084504
Name:LEE, ANDREW SUNGJAE (DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SUNGJAE
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60498
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91116-6498
Mailing Address - Country:US
Mailing Address - Phone:626-744-9222
Mailing Address - Fax:626-744-9229
Practice Address - Street 1:345 S LAKE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5030
Practice Address - Country:US
Practice Address - Phone:626-744-9222
Practice Address - Fax:626-744-9229
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32102225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic