Provider Demographics
NPI:1619979598
Name:LENT, DOLLY KOOI (MD)
Entity type:Individual
Prefix:DR
First Name:DOLLY
Middle Name:KOOI
Last Name:LENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DOLLY
Other - Middle Name:KOOI
Other - Last Name:LENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:FAIRFAX HEALTH CENTER ,4375 FAIR LAKES COURT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:571-432-2600
Mailing Address - Fax:
Practice Address - Street 1:4375 FAIR LAKES CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-4234
Practice Address - Country:US
Practice Address - Phone:571-432-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101273457207R00000X
CO42249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01635522Medicaid
CO01635522Medicaid
COH53236Medicare UPIN