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General NPI Number Information
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NPI Number | 1003063397
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Entity Type | Individual
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Provider Name | JOHN CHONGWON LEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2008
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 660 N WESTMORELAND RD
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City | LAKE FOREST
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State | IL
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Zip | 60045-1659
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Country | US
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Telephone | 847-535-6217
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Fax |
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Provider Business Mailing Address
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Address Line | 2040 BIRCHWOOD AVE
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City | DES PLAINES
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State | IL
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Zip | 60018-3100
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Country | US
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Telephone | 847-772-2847
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Fax | 312-942-4228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036121633
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License Number State | IL
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