MEDICARE: MISOO WOO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA14505	TX
2	363A00000X	Physician Assistant	030900	NY

General Provider Information

NPI Number	:	1245806389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISOO WOO PA-C

Provider Business Mailing Address
First Line	:	6917 STATE HIGHWAY 161 APT 352
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2453
Country	:	US
Telephone Number	:	469-274-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	4375 BOOTH CALLOWAY RD STE 307
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-8364
Country	:	US
Telephone Number	:	469-274-2110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2021
Last Update Date	:	01/15/2025

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Directions to “ MISOO WOO PA-C” Practice Location

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