Provider Demographics
NPI:1174575831
Name:LEE, MOONHEE (MD)
Entity type:Individual
Prefix:DR
First Name:MOONHEE
Middle Name:
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 1:3939 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2784
Mailing Address - Country:US
Mailing Address - Phone:817-457-3939
Mailing Address - Fax:817-457-3114
Practice Address - Street 1:3939 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2784
Practice Address - Country:US
Practice Address - Phone:817-457-3939
Practice Address - Fax:817-457-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3693207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127681801Medicaid
TX00B41XMedicare ID - Type UnspecifiedMEDICARE ID
TX127681801Medicaid