Healthcare Provider Details

I. General information

NPI: 1841080553
Provider Name (Legal Business Name): HEONSEOK LEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HAROLD LEE DO

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

IV. Provider business mailing address

219 E GRAND AVE APT 211
DES MOINES IA
50309-1851
US

V. Phone/Fax

Practice location:
  • Phone: 571-643-8333
  • Fax:
Mailing address:
  • Phone: 571-643-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR-13612
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: