Provider Demographics
NPI:1740402874
Name:LEE, DAVID WOOSUK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WOOSUK
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 1:902 W RANDOL MILL RD STE 250
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2584
Mailing Address - Country:US
Mailing Address - Phone:817-417-9334
Mailing Address - Fax:817-417-9339
Practice Address - Street 1:902 W RANDOL MILL RD STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2581
Practice Address - Country:US
Practice Address - Phone:817-417-9334
Practice Address - Fax:817-417-9339
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97378207R00000X
TXM9444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195347301Medicaid
TX195347303Medicaid
TX195347302Medicaid
TX195347304Medicaid
TX8L0819Medicare PIN
TX8L19150Medicare PIN
TX8L0780Medicare PIN
TX195347304Medicaid