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General NPI Number Information
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NPI Number | 1750739892
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Entity Type | Organization
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Legal Business Name | JIM LEE DDS PC
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 05/31/2016
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Provider Practice Location Address
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Address Line | 2616 SHERWOOD HALL LN SUITE #301
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3100
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Country | US
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Telephone | 202-423-8867
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Fax |
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Provider Business Mailing Address
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Address Line | 7515 COLLINS MEADE WAY
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5251
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Country | US
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Telephone | 202-423-8867
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIM MING AN LEE
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Credential | DDS
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Telephone | 202-423-8867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0401414622
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License Number State | VA
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