Provider Demographics
NPI:1376797753
Name:LEE, IL WOO (LAC)
Entity Type:Individual
Prefix:MR
First Name:IL WOO
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 ROYAL LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-7819
Mailing Address - Country:US
Mailing Address - Phone:972-241-0193
Mailing Address - Fax:972-241-0193
Practice Address - Street 1:2257 ROYAL LN
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-7819
Practice Address - Country:US
Practice Address - Phone:972-241-0193
Practice Address - Fax:972-241-0193
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12589171100000X
TXAC01318171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist