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NPI Code Detail

MEDICARE: DR. JUHYUN LEE DO

MEDICARE: DR. JUHYUN LEE DO
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
1390200000XStudent in an Organized Health Care Education/Training Program
22085B0100XBody Imaging Physician125.077561IL
3208D00000XGeneral Practice Physician125.077561IL

General Provider Information

NPI Number : 1558989798
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUHYUN LEE DO
Provider Business Mailing Address
First Line : 1653 W CONGRESS PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60612-3833
Country : US
Telephone Number : 312-942-5759
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-9000
Fax Number : 708-216-0899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2020
Last Update Date : 04/23/2026

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