Provider Demographics
NPI:1033462361
Name:LEE, CHANG HA (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANG HA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 WALNUT ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4738
Mailing Address - Country:US
Mailing Address - Phone:703-865-5899
Mailing Address - Fax:703-865-6199
Practice Address - Street 1:3930 WALNUT ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4738
Practice Address - Country:US
Practice Address - Phone:703-865-5899
Practice Address - Fax:703-865-6199
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03697111N00000X
VA0104557024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor