Provider Demographics
NPI:1811921794
Name:LEE, JONGMYEONG (MD)
Entity type:Individual
Prefix:DR
First Name:JONGMYEONG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7501 LITTLE RIVER TPKE STE 304
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2923
Mailing Address - Country:US
Mailing Address - Phone:703-965-3103
Mailing Address - Fax:703-712-8053
Practice Address - Street 1:7501 LITTLE RIVER TPKE STE 304
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2923
Practice Address - Country:US
Practice Address - Phone:703-965-3103
Practice Address - Fax:703-712-8053
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01078563A207Q00000X
PA462485207Q00000X
VA0101269292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine