Provider Demographics
NPI:1528244670
Name:LEE, TAE YONG (DDS)
Entity type:Individual
Prefix:DR
First Name:TAE YONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 LITTLE RIVER TPKE STE C
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3200
Mailing Address - Country:US
Mailing Address - Phone:703-256-7100
Mailing Address - Fax:
Practice Address - Street 1:7002 LITTLE RIVER TPKE STE C
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3200
Practice Address - Country:US
Practice Address - Phone:703-256-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist