Provider Demographics
NPI:1235605403
Name:SI-HYEON LEE, DMD, PC
Entity Type:Organization
Organization Name:SI-HYEON LEE, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SI-HYEON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-939-7234
Mailing Address - Street 1:21131 POTOMAC TRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4371
Mailing Address - Country:US
Mailing Address - Phone:703-939-7234
Mailing Address - Fax:
Practice Address - Street 1:381 GATEWAY DR STE 9
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22603-5852
Practice Address - Country:US
Practice Address - Phone:540-773-3206
Practice Address - Fax:540-773-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental