Provider Demographics
NPI:1891881058
Name:HINES VA HOSPITAL
Entity Type:Organization
Organization Name:HINES VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-202-2844
Mailing Address - Street 1:10600 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5110
Mailing Address - Country:US
Mailing Address - Phone:708-409-8450
Mailing Address - Fax:708-202-7936
Practice Address - Street 1:10600 31ST ST
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5110
Practice Address - Country:US
Practice Address - Phone:708-409-8450
Practice Address - Fax:708-202-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2865X1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)