Provider Demographics
NPI:1780670018
Name:NHO, JAI JUNG (MD)
Entity Type:Individual
Prefix:
First Name:JAI
Middle Name:JUNG
Last Name:NHO
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 1:15 COMMERCE DR STE 113
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7807
Mailing Address - Country:US
Mailing Address - Phone:847-231-5300
Mailing Address - Fax:847-231-5303
Practice Address - Street 1:15 COMMERCE DR STE 113
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7807
Practice Address - Country:US
Practice Address - Phone:847-231-5300
Practice Address - Fax:847-231-5303
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052229OtherPHYSICIAN LICENSE
0491507812OtherBLUE CROSS BLUE SHIELD
IL036052229Medicaid
C38307Medicare UPIN