Healthcare Provider Details

I. General information

NPI: 1821823543
Provider Name (Legal Business Name): SEOK HYEONG LEE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 307 BOX 2145
APO AP
96224-0022
US

IV. Provider business mailing address

8300 WISCONSIN AVE APT 543
BETHESDA MD
20814-3196
US

V. Phone/Fax

Practice location:
  • Phone: 336-596-9111
  • Fax:
Mailing address:
  • Phone: 336-596-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1240458
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: