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NPI Code Detail

MEDICARE: DR. KIE D. LEE DDS

MEDICARE: DR. KIE D. 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
1122300000XDentist0401005616VA

General Provider Information

NPI Number : 1871785022
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIE D. LEE DDS
Provider Business Mailing Address
First Line : 6220 OLD KEENE MILL CT
Second Line :
City : SPRINGFIELD
State : VA
Zip : 22152-2323
Country : US
Telephone Number : 703-569-8000
Fax Number : 703-569-9420
Provider Business Practice Location Address
First Line : 6220 OLD KEENE MILL CT
Second Line :
City : SPRINGFIELD
State : VA
Zip : 22152-2323
Country : US
Telephone Number : 703-569-8000
Fax Number : 703-569-9420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2007
Last Update Date : 08/13/2007

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