Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 019028580 | IL |
NPI | 1114211653 |
---|---|
Provider Name | Wei Ting Ho |
First Address | Chicago, IL 60602-1708 |
Second Address | Chicago, IL 60602-1708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 10/09/2014 |