Healthcare Provider Details

I. General information

NPI: 1295690709
Provider Name (Legal Business Name): CHAE WOON LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

240 DESERT PASS ST APT 2008
EL PASO TX
79912-3627
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-6000
  • Fax:
Mailing address:
  • Phone: 915-274-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number48708
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: