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General NPI Number Information
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NPI Number | 1811921794
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Entity Type | Individual
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Provider Name | JONGMYEONG LEE MD
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Gender | Female
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 7501 LITTLE RIVER TPKE STE 304
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City | ANNANDALE
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State | VA
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Zip | 22003-2923
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Country | US
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Telephone | 703-965-3103
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Fax | 703-712-8053
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Provider Business Mailing Address
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Address Line | 7501 LITTLE RIVER TPKE STE 304
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City | ANNANDALE
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State | VA
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Zip | 22003-2923
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Country | US
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Telephone | 703-965-3103
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Fax | 703-712-8053
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01078563A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 462485
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101269292
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License Number State | VA
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