Provider Demographics
NPI:1134115603
Name:LEE, JOSEPH YIM (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:YIM
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL STREET, NW, SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:211 GIBSON STREET, NW, SUITE 215
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2115
Practice Address - Country:US
Practice Address - Phone:571-707-2085
Practice Address - Fax:571-291-9196
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134115603Medicaid
VA05606594Medicaid
VA30016536180001Medicaid
080156200OtherRR MEDICARE
G85455Medicare UPIN