Provider Demographics
NPI:1104670181
Name:LEE, UN CHAN (CAA)
Entity type:Individual
Prefix:
First Name:UN CHAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAA
Mailing Address - Street 1:10309 HATTON LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5523
Mailing Address - Country:US
Mailing Address - Phone:214-779-0880
Mailing Address - Fax:
Practice Address - Street 1:9835 N LAKE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-6210
Practice Address - Country:US
Practice Address - Phone:737-229-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant