Provider Demographics
NPI:1003550088
Name:LEE, SEON YEONG (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEON
Middle Name:YEONG
Last Name:LEE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11433 LOG RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8528
Mailing Address - Country:US
Mailing Address - Phone:205-276-1725
Mailing Address - Fax:
Practice Address - Street 1:1531 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-7604
Practice Address - Country:US
Practice Address - Phone:202-602-1672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014181601223G0001X
MD177401223G0001X
DCDEN20001781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice