Provider Demographics
NPI:1417914128
Name:DE HAN HOME MEDICAL EQUIPMENT & SUPPLIES, LLC.
Entity Type:Organization
Organization Name:DE HAN HOME MEDICAL EQUIPMENT & SUPPLIES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-470-9223
Mailing Address - Street 1:6035 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2943
Mailing Address - Country:US
Mailing Address - Phone:847-470-9223
Mailing Address - Fax:847-470-9221
Practice Address - Street 1:6035 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2943
Practice Address - Country:US
Practice Address - Phone:847-470-9223
Practice Address - Fax:847-470-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000710332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5626100001Medicare ID - Type Unspecified