Provider Demographics
NPI:1073772539
Name:CHAN, LEE HA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEE HA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 FRONTIER AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-5200
Mailing Address - Country:US
Mailing Address - Phone:425-831-2300
Mailing Address - Fax:
Practice Address - Street 1:3710 PROVIDENCE POINT DR SE
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6242
Practice Address - Country:US
Practice Address - Phone:425-677-5938
Practice Address - Fax:425-642-8114
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60181298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8916919Medicare PIN