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General NPI Number Information
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NPI Number | 1770060279
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Entity Type | Individual
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Provider Name | SOOKYON LIM LEE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2018
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 401 CARPENTER RD BLDG 525
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City | FORT MYER
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State | VA
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Zip | 22211-1009
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Country | US
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Telephone | 703-678-3003
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Fax |
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Provider Business Mailing Address
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Address Line | ANDREW RADER DENTAL CLINIC 401 CARPENTER RD.
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City | ARLINGTON
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State | VA
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Zip | 22204
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Country | US
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Telephone | 703-678-3003
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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 | 30.025449
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License Number State | OH
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