Provider Demographics
NPI:1427283563
Name:LEE, JUNSOO ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:JUNSOO
Middle Name:ALEXANDER
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 TOWN CENTER DR STE 405
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3218
Mailing Address - Country:US
Mailing Address - Phone:703-481-9191
Mailing Address - Fax:571-423-5082
Practice Address - Street 1:1830 TOWN CENTER DR STE 405
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3218
Practice Address - Country:US
Practice Address - Phone:703-481-9191
Practice Address - Fax:571-423-5082
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101250996207RC0000X, 207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101250996OtherVIRGINIA STATE LICENSE