Provider Demographics
NPI:1902596794
Name:LEE, JUNG HYUN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUNG HYUN
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 DISTRICT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2278
Mailing Address - Country:US
Mailing Address - Phone:571-533-3752
Mailing Address - Fax:571-533-5762
Practice Address - Street 1:2905 DISTRICT AVE STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2278
Practice Address - Country:US
Practice Address - Phone:571-533-3752
Practice Address - Fax:571-533-3762
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist