Provider Demographics
NPI:1255432019
Name:LEE, HYO RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:HYO
Middle Name:RAE
Last Name:LEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2 CARDINAL PARK DR SE
Mailing Address - Street 2:SUITE 106A
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4448
Mailing Address - Country:US
Mailing Address - Phone:703-779-7900
Mailing Address - Fax:703-779-7903
Practice Address - Street 1:2 CARDINAL DR
Practice Address - Street 2:SUITE 106A
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4448
Practice Address - Country:US
Practice Address - Phone:703-779-7900
Practice Address - Fax:703-779-7903
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics