1992069918 NPI number — DR. EUN YOUNG LEE DDS, MSD, PHD

Table of content: DR. EUN YOUNG LEE DDS, MSD, PHD (NPI 1992069918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992069918 NPI number — DR. EUN YOUNG LEE DDS, MSD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
EUN YOUNG
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MSD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992069918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8381 OLD COURTHOUSE RD SUITE 100
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22182-3818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-570-7870
Provider Business Mailing Address Fax Number:
703-745-5905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8381 OLD COURTHOUSE RD SUITE 100
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22182-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-570-7870
Provider Business Practice Location Address Fax Number:
703-745-5905
Provider Enumeration Date:
06/25/2012

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: 1223E0200X , with the licence number:  0401413569 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 085437900 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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