Provider Demographics
NPI:1609405653
Name:LEE, HEE CHONG JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:HEE CHONG
Middle Name:JENNIFER
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:HEE CHONG
Other - Middle Name:JENNIFER
Other - Last Name:YOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746721
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6721
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:850 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-1902
Practice Address - Country:US
Practice Address - Phone:773-377-7304
Practice Address - Fax:773-634-7965
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036.165856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program