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General NPI Number Information
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NPI Number | 1982916672
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Entity Type | Individual
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Provider Name | JI HEON PAUL LEE M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 5721 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1425
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Country | US
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Telephone | 773-702-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 549 W ALDINE AVE APT 8
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City | CHICAGO
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State | IL
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Zip | 60657-3718
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Country | US
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Telephone | 917-750-9499
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125.057756
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License Number State | IL
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