Provider Demographics
NPI:1083897888
Name:HO, VIVIEN T (MD)
Entity Type:Individual
Prefix:
First Name:VIVIEN
Middle Name:T
Last Name:HO
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 1:1870 W GALENA BLVD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4356
Mailing Address - Country:US
Mailing Address - Phone:630-859-6700
Mailing Address - Fax:630-906-5941
Practice Address - Street 1:1870 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4356
Practice Address - Country:US
Practice Address - Phone:630-859-6700
Practice Address - Fax:630-906-5941
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-116895OtherIL LICENSE
IL0727500001Medicare NSC
IL036-116895OtherIL LICENSE
ILK48681Medicare PIN