MEDICARE: PROF. ALAN CHONG W. LEE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	20281	CA

General Provider Information

NPI Number	:	1457562803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. ALAN CHONG W. LEE DPT

Provider Business Mailing Address
First Line	:	3107 SITIO ISADORA
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-7123
Country	:	US
Telephone Number	:	213-477-2981
Fax Number	:	213-477-2609

Provider Business Practice Location Address
First Line	:	10 CHESTER PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-2518
Country	:	US
Telephone Number	:	213-477-2981
Fax Number	:	213-477-2609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/08/2007

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