Provider Demographics
NPI:1891096392
Name:LEE, KIT-YUNG (BBS, MS)
Entity Type:Individual
Prefix:
First Name:KIT-YUNG
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:BBS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 IDLE DAY DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1109
Mailing Address - Country:US
Mailing Address - Phone:917-273-4078
Mailing Address - Fax:
Practice Address - Street 1:7 IDLE DAY DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1109
Practice Address - Country:US
Practice Address - Phone:917-273-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist