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General NPI Number Information
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NPI Number | 1871220376
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Entity Type | Individual
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Provider Name | JUNGSEOK LEE
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Gender | Male
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 1220 W TRINITY MILLS RD # 430
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City | CARROLLTON
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State | TX
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Zip | 75006-1303
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Country | US
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Telephone | 469-465-8586
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Fax |
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Provider Business Mailing Address
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Address Line | 4545 MISSION AVE APT 3067
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City | FRISCO
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State | TX
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Zip | 75034-0295
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Country | US
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Telephone | 469-894-9613
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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