Provider Demographics
NPI:1790668291
Name:LEE, JI YEON (CPNP-PC)
Entity type:Individual
Prefix:
First Name:JI YEON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 4TH ST SW APT 206
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-2347
Mailing Address - Country:US
Mailing Address - Phone:412-927-9836
Mailing Address - Fax:
Practice Address - Street 1:1801 MISSISSIPPI AVE SE STE 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6121
Practice Address - Country:US
Practice Address - Phone:202-436-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP500025010208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics