Provider Demographics
NPI:1063686053
Name:HOR, TIFFANY KHUN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:KHUN
Last Name:HOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:PROFESSIONAL BUILDING SUITE #250
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-6163
Mailing Address - Fax:312-563-2096
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:PROFESSIONAL BUILDING SUITE #250
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-6163
Practice Address - Fax:312-563-2096
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036116064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine