Provider Demographics
NPI:1205989993
Name:ASSOCIATES IN EAR NOSE & THROAT AND HEAD & NECK SURGERY
Entity type:Organization
Organization Name:ASSOCIATES IN EAR NOSE & THROAT AND HEAD & NECK SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONGWOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-742-7458
Mailing Address - Street 1:2050 LARKIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5888
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:60123-4405
Practice Address - Country:US
Practice Address - Phone:847-742-7458
Practice Address - Fax:847-742-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042003973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL638150Medicare ID - Type Unspecified