Provider Demographics
NPI:1871220376
Name:LEE, JUNGSEOK
Entity type:Individual
Prefix:
First Name:JUNGSEOK
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 MISSION AVE APT 3067
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0295
Mailing Address - Country:US
Mailing Address - Phone:469-894-9613
Mailing Address - Fax:
Practice Address - Street 1:1220 W TRINITY MILLS RD # 430
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-1303
Practice Address - Country:US
Practice Address - Phone:469-465-8586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer