Provider Demographics
NPI:1154951960
Name:LEE, CHUNG H
Entity type:Individual
Prefix:
First Name:CHUNG
Middle Name:H
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 STRINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3915
Mailing Address - Country:US
Mailing Address - Phone:516-568-3010
Mailing Address - Fax:
Practice Address - Street 1:21 STRINGHAM AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3915
Practice Address - Country:US
Practice Address - Phone:516-568-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications