Healthcare Provider Details

I. General information

NPI: 1063745644
Provider Name (Legal Business Name): HOJIN LEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 PENDER DR STE 330
FAIRFAX VA
22030-0986
US

IV. Provider business mailing address

3930 PENDER DR STE 330
FAIRFAX VA
22030-0986
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-0022
  • Fax: 703-722-8682
Mailing address:
  • Phone: 703-246-0022
  • Fax: 703-722-8682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number267662
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0090694
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101272484
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: