Provider Demographics
NPI:1346778644
Name:LEE, SHANE HOON (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:HOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23900 KATY FWY STE 400
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1323
Mailing Address - Country:US
Mailing Address - Phone:281-644-8861
Mailing Address - Fax:281-644-8144
Practice Address - Street 1:23900 KATY FWY STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1323
Practice Address - Country:US
Practice Address - Phone:281-644-8861
Practice Address - Fax:281-644-8144
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA324060207Q00000X
TXT2425208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2555499Medicaid
LA324060OtherSTATE LICENSE