Provider Demographics
NPI:1821362112
Name:LEE, YOUNG SUK (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:YOUNG
Middle Name:SUK
Last Name:LEE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 MANOR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2241
Mailing Address - Country:US
Mailing Address - Phone:214-909-8447
Mailing Address - Fax:
Practice Address - Street 1:11661 PRESTON RD STE 218
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6173
Practice Address - Country:US
Practice Address - Phone:214-363-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-04
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily