Provider Demographics
NPI:1760421036
Name:LEE, WAI-KWAN I (MD)
Entity Type:Individual
Prefix:
First Name:WAI-KWAN
Middle Name:I
Last Name:LEE
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 1:2552 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3777
Mailing Address - Country:US
Mailing Address - Phone:718-777-6695
Mailing Address - Fax:
Practice Address - Street 1:2552 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11103-3777
Practice Address - Country:US
Practice Address - Phone:718-777-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169992207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01089165Medicaid
NYG77600Medicare UPIN
NY01089165Medicaid