Provider Demographics
NPI:1245858356
Name:LEE, SOLOMON WANSOO
Entity type:Individual
Prefix:
First Name:SOLOMON
Middle Name:WANSOO
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7004 LITTLE RIVER TPKE STE I
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3201
Mailing Address - Country:US
Mailing Address - Phone:703-445-6446
Mailing Address - Fax:703-763-7763
Practice Address - Street 1:7004 LITTLE RIVER TPKE STE I
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3201
Practice Address - Country:US
Practice Address - Phone:703-445-6446
Practice Address - Fax:703-763-7763
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000973171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist