Provider Demographics
NPI:1528525433
Name:LEE, DUKYONG (DOCTORATE)
Entity type:Individual
Prefix:DR
First Name:DUKYONG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DOCTORATE
Other - Prefix:DR
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13504 CLEAR LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-3610
Mailing Address - Country:US
Mailing Address - Phone:703-999-9371
Mailing Address - Fax:844-296-0284
Practice Address - Street 1:13504 CLEAR LAKE CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3610
Practice Address - Country:US
Practice Address - Phone:703-999-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist