Healthcare Provider Details

I. General information

NPI: 1730499005
Provider Name (Legal Business Name): MS. TAESOON LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE.
WASHINGTON D.C DC
20307
US

IV. Provider business mailing address

14717 POMMEL DR.
ROCKVILLE MD
20850
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number033384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: