Provider Demographics
NPI:1568777852
Name:JOHN H STROGER HOSPITAL
Entity Type:Organization
Organization Name:JOHN H STROGER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE/RESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HERMINA
Authorized Official - Middle Name:KUNG
Authorized Official - Last Name:JEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-828-8746
Mailing Address - Street 1:2057 MARK CIR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4916
Mailing Address - Country:US
Mailing Address - Phone:510-828-8746
Mailing Address - Fax:312-864-9725
Practice Address - Street 1:627 S WOOD ST
Practice Address - Street 2:RM 832A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3821
Practice Address - Country:US
Practice Address - Phone:312-333-8779
Practice Address - Fax:312-864-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1568777852OtherHMO
IL1568777852OtherPPO
IL1568777852Medicaid
IL1568777852Medicaid