Provider Demographics
NPI:1942293303
Name:LEE, FU-LIN YANG (PHD)
Entity type:Individual
Prefix:
First Name:FU-LIN
Middle Name:YANG
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10101 DANIELS RUN WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2451
Mailing Address - Country:US
Mailing Address - Phone:703-847-0459
Mailing Address - Fax:703-268-5086
Practice Address - Street 1:3949 PENDER DR
Practice Address - Street 2:SUITE 301
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6033
Practice Address - Country:US
Practice Address - Phone:703-847-0459
Practice Address - Fax:703-268-5086
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002207103TC1900X
DCPSY1000244103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA257647OtherKAISER PERMANANTE
VA208921OtherANTHEM BCBS
VA257647OtherKAISER PERMANANTE
VA208921OtherANTHEM BCBS
VALE778390Medicare ID - Type Unspecified