Provider Demographics
NPI:1831515865
Name:LEE, CHI-CHAN (MD)
Entity type:Individual
Prefix:MR
First Name:CHI-CHAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20900 BISCAYNE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1407
Mailing Address - Country:US
Mailing Address - Phone:305-682-7000
Mailing Address - Fax:305-682-5253
Practice Address - Street 1:20900 BISCAYNE BOULEVARD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1407
Practice Address - Country:US
Practice Address - Phone:305-682-7000
Practice Address - Fax:305-682-5253
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2021-04-09
Deactivation Date:2014-10-21
Deactivation Code:
Reactivation Date:2014-11-25
Provider Licenses
StateLicense IDTaxonomies
390200000X
GUM-2235207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program