Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 021.002274 | IL |
N | 1223G0001X | General Practice | 019.027600 | IL |
N | 213EG0000X | General Practice | 019.027600 | IL |
N | 1223G0001X | General Practice | 2005015642 | MO |
N | 213EG0000X | General Practice | 2005015642 | MO |
N | 1223G0001X | General Practice | 6602 | NE |
N | 213EG0000X | General Practice | 6602 | NE |
NPI | 1144477902 |
---|---|
Provider Name | Dr. Tae-Sok Kong |
First Address | Palos Heights, IL 60463-1001 |
Second Address | Palos Heights, IL 60463-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2008 |
Last Update Date | 24/08/2008 |