Provider Demographics
NPI:1003932765
Name:PANA OB-GYN
Entity Type:Organization
Organization Name:PANA OB-GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HWA-LONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:217-287-7477
Mailing Address - Street 1:101 E 9TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1716
Mailing Address - Country:US
Mailing Address - Phone:217-562-9276
Mailing Address - Fax:217-287-7511
Practice Address - Street 1:115 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1560
Practice Address - Country:US
Practice Address - Phone:217-287-7477
Practice Address - Fax:217-287-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
ILD89416Medicare UPIN
IL143972Medicare ID - Type Unspecified