Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036045849 | IL |
NPI | 1073578613 |
---|---|
Provider Name | Dr. Hyun Jae Ihm |
First Address | Elgin, IL 60123-2306 |
Second Address | Elgin, IL 60123-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 02/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036045849 | (05) | IL |
C39521 | (02) | IL |