Provider Demographics
NPI:1700838992
Name:HAM, JONGWOOK (MD)
Entity Type:Individual
Prefix:
First Name:JONGWOOK
Middle Name:
Last Name:HAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 LARKIN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-742-7458
Mailing Address - Fax:847-742-0191
Practice Address - Street 1:2050 LARKIN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-742-7458
Practice Address - Fax:847-742-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109196207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109196Medicaid
IL791041149OtherRAILROAD MEDICARE
IL04500559OtherBCBS