Healthcare Provider Details

I. General information

NPI: 1285598920
Provider Name (Legal Business Name): EUNKANG LEE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 HARWOOD RD APT 204I
BEDFORD TX
76021-3784
US

IV. Provider business mailing address

2910 HARWOOD RD APT 204I
BEDFORD TX
76021-3784
US

V. Phone/Fax

Practice location:
  • Phone: 803-230-2250
  • Fax:
Mailing address:
  • Phone: 803-230-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1190917
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: