Provider Demographics
NPI:1609870534
Name:LEE, WHA JOON (MD)
Entity Type:Individual
Prefix:DR
First Name:WHA JOON
Middle Name:
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 1:4000 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7854
Mailing Address - Country:US
Mailing Address - Phone:903-454-6481
Mailing Address - Fax:903-454-6486
Practice Address - Street 1:4000 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7854
Practice Address - Country:US
Practice Address - Phone:903-454-6481
Practice Address - Fax:903-454-6486
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00107003OtherRR MEDICARE
78842OtherBLUE CROSS
P00085272OtherRR MEDICARE
TX204632801Medicaid
ME87364OtherWORKER'S COMP
FL268207900Medicaid
78842ZMedicare ID - Type Unspecified
FL268207900Medicaid
ME87364OtherWORKER'S COMP
78842Medicare ID - Type Unspecified
TXP00825990Medicare PIN
P00085272OtherRR MEDICARE