Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 0101268762 | VA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 0101268762 | VA |
NPI | 1083971410 |
---|---|
Provider Name | Dr. Jae In Lee |
First Address | Falls Church, VA 22042-1263 |
Second Address | Leesburg, VA 20176-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 27/08/2021 |