Provider Demographics
NPI:1114932555
Name:FIRST CLINIC SC
Entity Type:Organization
Organization Name:FIRST CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-933-0500
Mailing Address - Street 1:PO BOX 5177
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5177
Mailing Address - Country:US
Mailing Address - Phone:847-933-0500
Mailing Address - Fax:847-933-0505
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:#405
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-933-0500
Practice Address - Fax:847-933-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31604612OtherBCBSIL
IL036084803Medicaid
IL31604612OtherBCBSIL
IL036084803Medicaid