| Doctor Name: | JIWON LEE |
| NPI Number: | 1558641464 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MT 200476 |
| Business Practice Address: | 2001 W 86th St Indianapolis, IN - 462601902 |
| Business Phone Number: | 3176149850 |
| Business Fax Number: | 3176149655 |
| Mailing Address: | Po Box 7232-dept 165, INDIANAPOLIS |
| State: | IN |
| Postal Code: | 462077232 |
| Phone Number: | 3176149850 |
| Fax Number: | 8007310751 |
| NPI Enumeration Date: | 08/23/2011 |
| NPI Last Update Date: | 06/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MT 200476 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |