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General NPI Number Information
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NPI Number | 1427869171
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Entity Type | Individual
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Provider Name | JEANNIE SEJIN LEE PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 5501 BACKLICK RD STE 105
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3940
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Country | US
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Telephone | 703-564-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 BACKLICK RD STE 105
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City | SPRINGFIELD
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State | VA
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Zip | 22151-3940
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Country | US
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Telephone | 703-564-5998
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110011232
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 200002263
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License Number State | DC
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