Provider Demographics
NPI:1588076624
Name:LEE, ZIHO (MD)
Entity type:Individual
Prefix:DR
First Name:ZIHO
Middle Name:
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 1:675 N SAINT CLAIR ST STE 20-150
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5979
Mailing Address - Country:US
Mailing Address - Phone:312-695-8146
Mailing Address - Fax:312-695-7030
Practice Address - Street 1:675 N SAINT CLAIR ST STE 20-150
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5979
Practice Address - Country:US
Practice Address - Phone:312-695-8146
Practice Address - Fax:312-695-7030
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61027276208800000X
PAMD460313208800000X
IL036157989208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1588076624Medicaid