MEDICARE: JENNY K LEE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-093477	IL
2	207R00000X	Internal Medicine Physician	036.093477	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093759490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY K LEE M.D.

Provider Business Mailing Address
First Line	:	1333 W BELMONT AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5785
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 W BELMONT AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5785
Country	:	US
Telephone Number	:	312-926-3627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/04/2015

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Directions to “ JENNY K LEE M.D.” Practice Location

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