Provider Demographics
NPI:1710705801
Name:LEE, SEA WON
Entity type:Individual
Prefix:
First Name:SEA
Middle Name:WON
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 N MIDWEST BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3237
Mailing Address - Country:US
Mailing Address - Phone:405-448-6276
Mailing Address - Fax:
Practice Address - Street 1:1408 N MIDWEST BLVD APT C
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3237
Practice Address - Country:US
Practice Address - Phone:405-448-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-28
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health