MEDICARE: KENG LEE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1780100198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENG LEE

Provider Business Mailing Address
First Line	:	6823 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-6009
Country	:	US
Telephone Number	:	718-253-4477
Fax Number	:	718-253-0545

Provider Business Practice Location Address
First Line	:	9114 MERRICK BLVD FL 6
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-5363
Country	:	US
Telephone Number	:	718-674-6066
Fax Number	:

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

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	05/24/2024

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