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Individual

KYUNG JIN LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
F.N.P.

Contact information

Practice address
923 PENNSYLVANIA AVE., SUITE 100, FORT WORTH, TX 76104-2254
(817) 920-0484
(817) 920-0068
Mailing address
P. O. BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 920-0068

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
825423
TX

Other

Enumeration date
09/14/2012
Last updated
09/14/2012
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