Healthcare Provider Details

I. General information

NPI: 1073153805
Provider Name (Legal Business Name): YOUNG LEE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 UNIVERSITY BLVD W STE 400
SILVER SPRING MD
20902-1972
US

IV. Provider business mailing address

15245 SHADY GROVE RD STE 370
ROCKVILLE MD
20850-6237
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-0960
  • Fax: 301-933-1547
Mailing address:
  • Phone: 240-246-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR264316
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024177538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: