Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036.119026 | IL |
N | 208600000X | Surgeon | 036.119026 | IL |
Y | 2082S0105X | Plastic Hand Surgeon | 036.119026 | IL |
NPI | 1417145152 |
---|---|
Provider Name | Dr. Jason Hyunsuk Ko |
First Address | Chicago, IL 60611-8709 |
Second Address | Chicago, IL 60611-5975 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 28/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1417145152 | (05) | WA |