Provider Demographics
NPI:1346388832
Name:LEE, CHANG K (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANG
Middle Name:K
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 CROSSWYNDS DR
Mailing Address - Street 2:
Mailing Address - City:SAUNDERSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02874-2406
Mailing Address - Country:US
Mailing Address - Phone:401-295-7594
Mailing Address - Fax:401-847-5767
Practice Address - Street 1:1131 WARWICK AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3545
Practice Address - Country:US
Practice Address - Phone:401-785-9333
Practice Address - Fax:401-785-9433
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RI4398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC90714Medicare UPIN
RIO19001669Medicare ID - Type Unspecified