Basic Information
| Provider Information | |||||||||
| NPI: | 1609840628 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445945 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD424620 | PA | N | Other Service Providers | Specialist | 208600000X | MD424620 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 101300120 | 05 | PA | MEDICAID | 1550076 | 01 | PA | GATEWAY | OTHER | 20053870 | 01 | PA | MERCY | OTHER | 2406879000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 001740988 | 01 | PA | HIGHMARK | OTHER | 7590805 | 01 | PA | AETNA-NON HMO | OTHER | 1338949 | 01 | PA | AETNA-HMO | OTHER | P00332615 | 01 | PA | RR MEDICARE | OTHER | 50059366 | 01 | PA | CAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL | OTHER | 000000188116 | 01 | PA | UNISON | OTHER |