Healthcare Provider Details

I. General information

NPI: 1386325645
Provider Name (Legal Business Name): KYU MIN LEE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STARKEY RD
CAVE SPRING VA
24018-0619
US

IV. Provider business mailing address

4437 STARKEY RD
CAVE SPRING VA
24018-0619
US

V. Phone/Fax

Practice location:
  • Phone: 540-989-4093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14170
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: