Provider Demographics
NPI:1699262337
Name:LEE, EUNYOUNG
Entity type:Individual
Prefix:
First Name:EUNYOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 COBIA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6891
Mailing Address - Country:US
Mailing Address - Phone:346-338-9360
Mailing Address - Fax:
Practice Address - Street 1:440 COBIA DR STE 101
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6891
Practice Address - Country:US
Practice Address - Phone:346-338-9360
Practice Address - Fax:346-338-9370
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily