Provider Demographics
NPI:1235558214
Name:LEE, ALICE MINKYUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:MINKYUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1635 N GEORGE MASON DR STE 155
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3604
Mailing Address - Country:US
Mailing Address - Phone:703-297-9383
Mailing Address - Fax:703-717-7654
Practice Address - Street 1:1635 N GEORGE MASON DR STE 155
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3604
Practice Address - Country:US
Practice Address - Phone:703-297-9383
Practice Address - Fax:703-717-7654
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA101260987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty