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Individual

SO JUNG LEE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.M.D.

Contact information

Practice address
13880 BRADDOCK RD STE 109, CENTREVILLE, VA 20121-2460
(703) 830-9990
Mailing address
9450 FAIRFAX BLVD APT 1504, FAIRFAX, VA 22031-2422
(703) 969-4878

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401417223
VA
1223G0001X
General Practice Dentistry
30.026164
OH

Other

Enumeration date
06/03/2020
Last updated
04/22/2022
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