Provider Demographics
NPI:1598975070
Name:LEE, CHONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 TYSONS BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4865
Mailing Address - Country:US
Mailing Address - Phone:703-448-1020
Mailing Address - Fax:703-448-2442
Practice Address - Street 1:1600 TYSONS BLVD
Practice Address - Street 2:STE 120
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4865
Practice Address - Country:US
Practice Address - Phone:703-448-1020
Practice Address - Fax:703-448-2442
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA61411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice