Provider Demographics
NPI:1700847308
Name:LEE, JOHN HOON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 REMINGTON BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4920
Mailing Address - Country:US
Mailing Address - Phone:630-759-1248
Mailing Address - Fax:630-759-0717
Practice Address - Street 1:396 REMINGTON BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-4920
Practice Address - Country:US
Practice Address - Phone:630-759-1248
Practice Address - Fax:630-759-0717
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096001207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399980OtherGROUP PTAN
IL399980OtherGROUP PTAN
ILR03595OtherINDIVIDUAL PTAN
IN252000LMedicare PIN
IN200519360EMedicaid
INF43743Medicare UPIN
INP00235719Medicare PIN