Healthcare Provider Details

I. General information

NPI: 1679417174
Provider Name (Legal Business Name): ISAAC CK LEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N CALIFORNIA AVE
CHICAGO IL
60625-7014
US

IV. Provider business mailing address

300 N CANAL ST APT 2304
CHICAGO IL
60606-1305
US

V. Phone/Fax

Practice location:
  • Phone: 773-989-3808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: