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General NPI Number Information
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NPI Number | 1578143855
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Entity Type | Individual
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Provider Name | JENNIFER KHANH-VY LEE DDS
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 02/11/2023
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Provider Practice Location Address
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Address Line | 420 S PICKETT ST
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City | ALEXANDRIA
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State | VA
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Zip | 22304-4706
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Country | US
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Telephone | 202-743-5303
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Fax |
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Provider Business Mailing Address
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Address Line | 1298 DIFFICULT RUN CT
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City | VIENNA
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State | VA
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Zip | 22182-1400
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Country | US
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Telephone | 703-505-0340
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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 | 0401417620
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License Number State | VA
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