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General NPI Number Information
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NPI Number | 1003550088
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Entity Type | Individual
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Provider Name | SEON YEONG LEE DMD
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Gender | Female
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Dates
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Enumeration Date | 04/25/2022
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Last Update Date | 10/14/2022
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Provider Practice Location Address
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Address Line | 1531 MARYLAND AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20002-7604
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Country | US
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Telephone | 202-602-1672
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Fax |
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Provider Business Mailing Address
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Address Line | 11433 LOG RIDGE DR
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City | FAIRFAX
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State | VA
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Zip | 22030-8528
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Country | US
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Telephone | 205-276-1725
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401418160
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17740
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN2000178
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License Number State | DC
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