Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 016003687 | IL |
Y | 213ES0131X | Foot Surgery | 016003687 | IL |
NPI | 1487677076 |
---|---|
Provider Name | Dr. David T Hong |
First Address | Chicago, IL 60602-2301 |
Second Address | Chicago, IL 60602-3580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 11/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016003687 | (05) | IL |
60001532 | BLUE CROSS BLUE SHIELD (01) | IL |
T38268 | (02) | IL |