MEDICARE: JUNG HYUN LEE PHARMD

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	183500000X	Pharmacist	0202220917	VA

General Provider Information

NPI Number	:	1902596794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNG HYUN LEE PHARMD

Provider Business Mailing Address
First Line	:	2905 DISTRICT AVE STE 400
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2278
Country	:	US
Telephone Number	:	571-533-3752
Fax Number	:	571-533-5762

Provider Business Practice Location Address
First Line	:	2905 DISTRICT AVE STE 400
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2278
Country	:	US
Telephone Number	:	571-533-3752
Fax Number	:	571-533-3762

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

Provider Enumeration Date	:	05/15/2023
Last Update Date	:	05/19/2023

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