Provider Demographics
NPI:1568621241
Name:LEE, SIMON (DIPL AC)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 S ARCHER AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5022
Mailing Address - Country:US
Mailing Address - Phone:312-593-1780
Mailing Address - Fax:
Practice Address - Street 1:5115 N RAVENSWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2712
Practice Address - Country:US
Practice Address - Phone:773-878-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist