Provider Demographics
NPI:1215558929
Name:LEE, WANGSOO
Entity Type:Individual
Prefix:
First Name:WANGSOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10510 PARK LN APT 311
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1732
Mailing Address - Country:US
Mailing Address - Phone:216-577-7722
Mailing Address - Fax:
Practice Address - Street 1:1720 2ND AVE S # 412
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-1732
Practice Address - Country:US
Practice Address - Phone:205-934-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program