Healthcare Provider Details

I. General information

NPI: 1134851546
Provider Name (Legal Business Name): JAMES JOONSOO LEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PARK AVE STE 305
FALLS CHURCH VA
22046-3303
US

IV. Provider business mailing address

301 W BROAD ST APT 658
FALLS CHURCH VA
22046-3376
US

V. Phone/Fax

Practice location:
  • Phone: 703-783-2345
  • Fax:
Mailing address:
  • Phone: 267-918-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401418852
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: