Provider Demographics
NPI:1609840628
Name:LEE, JOHN CHUNG (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHUNG
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 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424620174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101300120Medicaid
PA1550076OtherGATEWAY
PA20053870OtherMERCY
PA2406879000OtherINDEPENDENCE BLUE CROSS
PA001740988OtherHIGHMARK
PA7590805OtherAETNA-NON HMO
PA1338949OtherAETNA-HMO
PAP00332615OtherRR MEDICARE
PA50059366OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA000000188116OtherUNISON
PA001740988OtherHIGHMARK
PA1550076OtherGATEWAY