MEDICARE: DR. HYO RAE LEE DDS

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	1223E0200X	Endodontics	0401410574	VA

General Provider Information

NPI Number	:	1255432019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYO RAE LEE DDS

Provider Business Mailing Address
First Line	:	2 CARDINAL PARK DR SE
Second Line	:	SUITE 106A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4448
Country	:	US
Telephone Number	:	703-779-7900
Fax Number	:	703-779-7903

Provider Business Practice Location Address
First Line	:	2 CARDINAL DR
Second Line	:	SUITE 106A
City	:	LEESBURG
State	:	VA
Zip	:	20175-4448
Country	:	US
Telephone Number	:	703-779-7900
Fax Number	:	703-779-7903

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	07/08/2007

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