Provider Demographics
NPI:1609233287
Name:LEE, MIN KYUNG
Entity Type:Individual
Prefix:
First Name:MIN KYUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 OLD DENTON RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1440
Mailing Address - Country:US
Mailing Address - Phone:972-245-0028
Mailing Address - Fax:972-245-0029
Practice Address - Street 1:2324 OLD DENTON RD
Practice Address - Street 2:STE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1440
Practice Address - Country:US
Practice Address - Phone:972-245-0028
Practice Address - Fax:972-245-0029
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily