Basic Information
| Provider Information | |||||||||
| NPI: | 1982919627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | KYUNG HWA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 E CHICAGO AVE | ||||||||
| Address2: | WARD 3-140 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125038223 | ||||||||
| FaxNumber: | 3125038249 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 N FAIRBANKS CT | ||||||||
| Address2: | OLSON 2-460 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125038223 | ||||||||
| FaxNumber: | 3125038249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 08/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZN0500X | 125058964 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Neuropathology |
No ID Information.