Provider Demographics
NPI:1235333402
Name:LEE, TAE YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 FAIRWAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-221-1741
Mailing Address - Fax:972-939-2822
Practice Address - Street 1:560 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3629
Practice Address - Country:US
Practice Address - Phone:972-221-1741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM87872084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0022474OtherINSTITUTIONAL PERMIT