Provider Demographics
NPI:1780100198
Name:LEE, KENG
Entity type:Individual
Prefix:
First Name:KENG
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6823 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-6009
Mailing Address - Country:US
Mailing Address - Phone:718-253-4477
Mailing Address - Fax:718-253-0545
Practice Address - Street 1:9114 MERRICK BLVD FL 6
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5363
Practice Address - Country:US
Practice Address - Phone:718-674-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator