Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Jaekwan Lee

Individual provider Physical Therapist · NPI 1417512203

Mr. Jaekwan Lee is a Physical Therapist in Private Practice in Flushing, New York. Qualified in 2017, 9 years ago. Practices as a sole proprietor, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
9
Licensed in
NY
In the registry since
2019
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Practice location Address checks out

16213 46th Ave Ste 3B
Flushing, NY 11358-3698
Phone: (929) 362-7708
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4525 162nd St, Flushing, NY 11358-3279 — (929) 362-7708

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 041462 (NY)

Record details

NPI number1417512203
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 7, 2019
Last updated in NPPESJune 2, 2021
Certification dateJune 2, 2021
Mailing address4362 162nd Street, 2nd Floor, Flushing, NY 11358

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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