Provider Demographics
NPI:1811202807
Name:LEE, ANDREW YONGKYU (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:YONGKYU
Last Name:LEE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11371 ARISTOTLE DR APT 208
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0941
Mailing Address - Country:US
Mailing Address - Phone:703-282-2572
Mailing Address - Fax:
Practice Address - Street 1:11371 ARISTOTLE DR APT 208
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-0941
Practice Address - Country:US
Practice Address - Phone:703-282-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer