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NPI Code Detail

MEDICARE: JOSEPH YAE-DAM LEE PA-C

MEDICARE: JOSEPH YAE-DAM LEE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0110011941VA

General Provider Information

NPI Number : 1063379543
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH YAE-DAM LEE PA-C
Provider Business Mailing Address
First Line : 1830 TOWN CENTER DR STE 405
Second Line :
City : RESTON
State : VA
Zip : 20190-3218
Country : US
Telephone Number : 703-481-9191
Fax Number :
Provider Business Practice Location Address
First Line : 1830 TOWN CENTER DR STE 405
Second Line :
City : RESTON
State : VA
Zip : 20190-3218
Country : US
Telephone Number : 703-481-9191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2026
Last Update Date : 05/25/2026

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