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NPI Code Detail

MEDICARE: DR. JACOB HYUNWOO LEE DMD

MEDICARE: DR. JACOB HYUNWOO LEE DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry70023720WA

General Provider Information

NPI Number : 1053298208
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB HYUNWOO LEE DMD
Provider Business Mailing Address
First Line : 10725 MARLBOROUGH RD
Second Line :
City : FAIRFAX
State : VA
Zip : 22032-2223
Country : US
Telephone Number : 571-730-7961
Fax Number :
Provider Business Practice Location Address
First Line : 4722 FAUNTLEROY WAY SW STE A
Second Line :
City : SEATTLE
State : WA
Zip : 98116-4667
Country : US
Telephone Number : 206-752-8761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2025
Last Update Date : 08/25/2025

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