Provider Demographics
NPI:1164625497
Name:LENZE, AUDREY KIM (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:KIM
Last Name:LENZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:JEONGAH
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 S MAPLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4243
Mailing Address - Country:US
Mailing Address - Phone:703-532-5436
Mailing Address - Fax:703-532-3232
Practice Address - Street 1:400 S MAPLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4243
Practice Address - Country:US
Practice Address - Phone:703-532-5436
Practice Address - Fax:703-532-3232
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242267207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine