MEDICARE: WONHEE LEE DDS MS PLLC

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
1	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1750969143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONHEE LEE DDS MS PLLC

Provider Business Mailing Address
First Line	:	7480 BIRDWOOD AVE APT 1310
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-7468
Country	:	US
Telephone Number	:	202-826-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	11800 SUNRISE VALLEY DR STE 250
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-5302
Country	:	US
Telephone Number	:	703-429-9926
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WONHEE LEE
Credential	:	DDS
Telephone Number	:	202-826-5134

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	04/08/2021

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