Provider Demographics
NPI:1497711873
Name:HONG, OK RO (MD)
Entity type:Individual
Prefix:
First Name:OK
Middle Name:RO
Last Name:HONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-544-5102
Mailing Address - Fax:847-544-5103
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-544-5102
Practice Address - Fax:847-544-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0739052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632426OtherBLUE CROSS BLUE SHIELD
IL036073905Medicaid
IL209473Medicare PIN
IL01632426OtherBLUE CROSS BLUE SHIELD