Provider Demographics
NPI:1689832487
Name:LEE, YOUNG JAI (DDS)
Entity type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:JAI
Last Name:LEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10313 GEORGIA AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-649-4197
Mailing Address - Fax:301-649-4197
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:STE 205
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-649-4197
Practice Address - Fax:301-649-4197
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist