Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 0104556582 | VA |
NPI | 1164695763 |
---|---|
Provider Name | Dr. Seungjae Lee |
First Address | Vienna, VA 22181-5570 |
Second Address | Reston, VA 20190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 04/04/2008 |