Kyung Jae Lee, D.C

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0104557322 Issued in VA

Practice address

209 Elden St Ste 302
Herndon, VA 20170-4847

Phone

(703) 520-9980

NPI assigned

May 24, 2016

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gravity Spine LLC

  • Chiropractor
  • Herndon, VA
  • NPI 1265069900
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1679921233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 ELDEN ST STE 302",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704847",
            "telephone_number": "571-451-4505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 ELDEN ST STE 302",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704847",
            "telephone_number": "703-520-9980"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "46090 Lake Center Plz",
            "address_2": "Suite 303",
            "address_purpose": "LOCATION",
            "city": "Potomac Falls",
            "state": "VA",
            "postal_code": "201655876",
            "country_code": "US",
            "telephone_number": "703-444-4030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "KYUNG",
        "middle_name": "JAE",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-24",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104557322",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "VA",
            "license": "0104557322",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angelic Marie Lee, APRN
• Dukyong Lee, DOCTORATE
• Eunjoo Lee, BCBA
• Hon K. Lee, L.AC., DIPL.O.M.
• Kevin J Lee, MD
• Matthew Lee, D.C.
• Patrick Kyle Lee
• Legacy Dental Implant of Herndon
• Legacy Healing & Therapy Services LLC
• Legacy Hustle Care Solutions Inc

• Chiropractor in Herndon, VA
• Providers in Herndon, VA by specialty
• Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.