Provider Demographics
NPI:1336159573
Name:LEE, YONG CHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:CHAN
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 1:3309 N HASKELL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1587
Mailing Address - Country:US
Mailing Address - Phone:214-675-8193
Mailing Address - Fax:
Practice Address - Street 1:12505 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8298
Practice Address - Country:US
Practice Address - Phone:972-963-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9315207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169848203Medicaid
TXP00869884OtherRRMCARE THRU IEPOS
TX169848203Medicaid
TX8F22599Medicare PIN