Provider Demographics
NPI:1295359966
Name:LEE, CHRISTOPHER RYAN WIN HUN
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RYAN WIN HUN
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10307 GATEWAY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SCARRBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-420-7259
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL STREET
Practice Address - Street 2:PSA #5323A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program