1619979598 NPI number — DR. DOLLY KOOI LENT M.D.

Table of content: DR. DOLLY KOOI LENT M.D. (NPI 1619979598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619979598 NPI number — DR. DOLLY KOOI LENT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENT
Provider First Name:
DOLLY
Provider Middle Name:
KOOI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LENT
Provider Other First Name:
DOLLY
Provider Other Middle Name:
KOOI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619979598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FAIRFAX HEALTH CENTER ,4375 FAIR LAKES COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-432-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4375 FAIR LAKES CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-432-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101273457 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 42249 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01635522 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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