Provider Demographics
NPI:1326127440
Name:CHONG SOO RIM M-D LTD
Entity Type:Organization
Organization Name:CHONG SOO RIM M-D LTD
Other - Org Name:CHONG S. RIM, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHONG
Authorized Official - Middle Name:SOO
Authorized Official - Last Name:RIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-275-4446
Mailing Address - Street 1:5140 N CALIFORNIA AVE
Mailing Address - Street 2:SUITE 715
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3645
Mailing Address - Country:US
Mailing Address - Phone:773-275-4446
Mailing Address - Fax:
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 715
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-275-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046303207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036046303Medicaid
212045OtherMEDICARE GROUP ID
IL36921508300OtherADVOCATE LUTHERAN GROUP #
IL21603473OtherBLUE SHIELD PROVIDER #
IL5039OtherADVOCATE LUTHERAN PIN #
IL36921508300OtherADVOCATE LUTHERAN GROUP #
ILK19805Medicare PIN
ILD12487Medicare UPIN