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NPI Code Detail

MEDICARE: ANDREW KANG LEE JR.

MEDICARE: ANDREW KANG LEE JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program35461TX

General Provider Information

NPI Number : 1710482146
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW KANG LEE JR.
Provider Business Mailing Address
First Line : 604 ALLEN RD
Second Line :
City : COPPELL
State : TX
Zip : 75019-3199
Country : US
Telephone Number : 469-261-4500
Fax Number :
Provider Business Practice Location Address
First Line : 2409 UNIVERSITY AVE
Second Line :
City : AUSTIN
State : TX
Zip : 78712-1112
Country : US
Telephone Number : 512-471-3434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2018
Last Update Date : 03/27/2018

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