Provider Demographics
NPI:1992025381
Name:LEE, KACHIU CECILIA (MD)
Entity Type:Individual
Prefix:
First Name:KACHIU
Middle Name:CECILIA
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 1:32 PARKING PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2415
Mailing Address - Country:US
Mailing Address - Phone:610-645-5551
Mailing Address - Fax:
Practice Address - Street 1:32 PARKING PLZ STE 200
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2415
Practice Address - Country:US
Practice Address - Phone:610-645-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14704207N00000X
MA258397207N00000X
PAMD466653207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology