Provider Demographics
NPI:1073578613
Name:IHM, HYUN JAE (MD)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:JAE
Last Name:IHM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1435 N RANDALL RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2306
Mailing Address - Country:US
Mailing Address - Phone:847-695-1620
Mailing Address - Fax:847-695-1954
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2306
Practice Address - Country:US
Practice Address - Phone:847-695-1620
Practice Address - Fax:847-695-1954
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036045849208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036045849Medicaid
ILC39521Medicare UPIN
ILPO5452Medicare PIN