Provider Demographics
NPI:1194883769
Name:LEE, CHI KEUNG (MD)
Entity type:Individual
Prefix:
First Name:CHI
Middle Name:KEUNG
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2999 REGENT ST STE 612
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2121
Mailing Address - Country:US
Mailing Address - Phone:510-848-1727
Mailing Address - Fax:510-848-8224
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:#612
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-848-1733
Practice Address - Fax:510-848-8224
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0838392088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49005YMedicaid
CAYYY49005YMedicaid
CAZZZ17211ZMedicare ID - Type Unspecified