Healthcare Provider Details

I. General information

NPI: 1912893991
Provider Name (Legal Business Name): SIN LEI PUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYDIA PUI MD

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

150 FOREST AVE UNIT 1304
OAK PARK IL
60301-1456
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.088355
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: