Provider Demographics
NPI:1093714719
Name:WHABA MEDICAL, INC.
Entity Type:Organization
Organization Name:WHABA MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SOON
Authorized Official - Last Name:WHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-893-9554
Mailing Address - Street 1:870 W LAKE ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-2893
Mailing Address - Country:US
Mailing Address - Phone:630-893-9554
Mailing Address - Fax:630-893-9568
Practice Address - Street 1:870 W LAKE ST
Practice Address - Street 2:SUITE 702
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-2893
Practice Address - Country:US
Practice Address - Phone:630-893-9554
Practice Address - Fax:630-893-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1112070001Medicare NSC