Provider Demographics
NPI:1033401138
Name:HA, DONGSIK (MSOM)
Entity Type:Individual
Prefix:
First Name:DONGSIK
Middle Name:
Last Name:HA
Suffix:
Gender:M
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GOLF MILL CTR
Mailing Address - Street 2:SUITE 824
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1224
Mailing Address - Country:US
Mailing Address - Phone:847-410-1052
Mailing Address - Fax:
Practice Address - Street 1:241 GOLF MILL CTR
Practice Address - Street 2:SUITE 824
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1224
Practice Address - Country:US
Practice Address - Phone:847-410-1052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist