Healthcare Provider Details

I. General information

NPI: 1720170855
Provider Name (Legal Business Name): INSOOK LEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 INNSLAKE DR SUITE 308
GLEN ALLEN VA
23060-3327
US

IV. Provider business mailing address

4050 INNSLAKE DR SUITE 308
GLEN ALLEN VA
23060-3327
US

V. Phone/Fax

Practice location:
  • Phone: 804-521-5315
  • Fax: 804-521-5312
Mailing address:
  • Phone: 804-521-5315
  • Fax: 804-521-5312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101045418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: