Provider Demographics
NPI:1093037673
Name:ADVANCED PEDIATRIC AND NEONATAL MEDICINE, SC
Entity Type:Organization
Organization Name:ADVANCED PEDIATRIC AND NEONATAL MEDICINE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:630-529-6969
Mailing Address - Street 1:473 W ARMY TRAIL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2674
Mailing Address - Country:US
Mailing Address - Phone:630-529-6969
Mailing Address - Fax:630-529-7497
Practice Address - Street 1:473 W ARMY TRAIL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2674
Practice Address - Country:US
Practice Address - Phone:630-529-6969
Practice Address - Fax:630-529-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360618122080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208000000XOtherTAXONOMY
IL036061812Medicaid
IL208000000XOtherTAXONOMY