MEDICARE: JUNGSEOK LEE

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1871220376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNGSEOK LEE

Provider Business Mailing Address
First Line	:	4545 MISSION AVE APT 3067
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-0295
Country	:	US
Telephone Number	:	469-894-9613
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 W TRINITY MILLS RD # 430
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-1303
Country	:	US
Telephone Number	:	469-465-8586
Fax Number	:

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

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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Directions to “ JUNGSEOK LEE ” Practice Location

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