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General NPI Number Information
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NPI Number | 1639788003
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Entity Type | Individual
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Provider Name | YOUNG JIN LEE
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Gender | Male
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 6399 RICHMOND RD STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1729
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Country | US
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Telephone | 757-941-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 6399 RICHMOND RD STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1729
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Country | US
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Telephone | 240-477-3825
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401417097
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License Number State | VA
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