Provider Demographics
NPI:1962464826
Name:LEE, JONG H (MD)
Entity Type:Individual
Prefix:
First Name:JONG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4325 N JOSEY LN
Mailing Address - Street 2:STE 103
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4635
Mailing Address - Country:US
Mailing Address - Phone:972-395-7131
Mailing Address - Fax:972-395-7585
Practice Address - Street 1:4325 N JOSEY LN
Practice Address - Street 2:STE 103
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4635
Practice Address - Country:US
Practice Address - Phone:972-395-7131
Practice Address - Fax:972-395-7585
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL2406207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162987502Medicaid
H85475Medicare UPIN
TX8F9309Medicare PIN