Provider Demographics
NPI:1245461367
Name:LEE, SI-HYEON (DMD)
Entity type:Individual
Prefix:DR
First Name:SI-HYEON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 DIAMOND SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-2284
Mailing Address - Country:US
Mailing Address - Phone:954-670-9626
Mailing Address - Fax:540-442-6622
Practice Address - Street 1:1920 MEDICAL AVE STE J
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8016
Practice Address - Country:US
Practice Address - Phone:540-432-9992
Practice Address - Fax:540-442-6622
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014125281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice