Provider Demographics
NPI:1992069918
Name:LEE, EUN YOUNG (DDS, MSD, PHD)
Entity type:Individual
Prefix:DR
First Name:EUN YOUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:
Credentials:DDS, MSD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8381 OLD COURTHOUSE RD SUITE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3818
Mailing Address - Country:US
Mailing Address - Phone:703-570-7870
Mailing Address - Fax:703-745-5905
Practice Address - Street 1:8381 OLD COURTHOUSE RD SUITE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3818
Practice Address - Country:US
Practice Address - Phone:703-570-7870
Practice Address - Fax:703-745-5905
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014135691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA085437900Medicaid