Provider Demographics
NPI:1255399465
Name:LEE, CHI KEI (PT)
Entity type:Individual
Prefix:MR
First Name:CHI KEI
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 UNION ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1256
Mailing Address - Country:US
Mailing Address - Phone:917-816-6423
Mailing Address - Fax:718-359-3398
Practice Address - Street 1:1803 MAHAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4621
Practice Address - Country:US
Practice Address - Phone:917-816-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A300019484OtherMEDICARE PTAN
12118853OtherCAQH PROVIDER ID