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General NPI Number Information
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NPI Number | 1417281221
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Entity Type | Organization
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Legal Business Name | JONG KOOK LEE MDPC
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 4605 PINECREST OFFICE PARK DR A
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1442
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Country | US
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Telephone | 703-256-6204
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Fax | 703-642-9034
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Provider Business Mailing Address
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Address Line | 4605 PINECREST OFFICE PARK DR A
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1442
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Country | US
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Telephone | 703-256-6204
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Fax | 703-642-9034
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONG K LEE
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Credential | MD
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Telephone | 703-256-6204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101033350
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License Number State | VA
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