Provider Demographics
NPI:1457562803
Name:LEE, ALAN CHONG W (DPT)
Entity Type:Individual
Prefix:PROF
First Name:ALAN
Middle Name:CHONG W
Last Name:LEE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 SITIO ISADORA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7123
Mailing Address - Country:US
Mailing Address - Phone:213-477-2981
Mailing Address - Fax:213-477-2609
Practice Address - Street 1:10 CHESTER PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2518
Practice Address - Country:US
Practice Address - Phone:213-477-2981
Practice Address - Fax:213-477-2609
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA202812251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics