MEDICARE: JENNI YOON LEE M.D.

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207K00000X	Allergy & Immunology Physician	D80546	MD

General Provider Information

NPI Number	:	1245528868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNI YOON LEE M.D.

Provider Business Mailing Address
First Line	:	267 KENTLANDS BLVD STE 4091
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-5446
Country	:	US
Telephone Number	:	888-463-6332
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 KENTLANDS BLVD STE 4091
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-5446
Country	:	US
Telephone Number	:	888-463-6332
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2011
Last Update Date	:	04/09/2026

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