Provider Demographics
NPI:1821600057
Name:LEE, KA WING
Entity type:Individual
Prefix:
First Name:KA WING
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 ELM REED AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2841
Mailing Address - Country:US
Mailing Address - Phone:626-348-9193
Mailing Address - Fax:
Practice Address - Street 1:6671 LAS VEGAS BLVD S UNIT 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3289
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:310-406-1531
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NVLBA0824103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVBACB585126OtherRBT PARAPROFESSIONAL