Healthcare Provider Details

I. General information

NPI: 1316530272
Provider Name (Legal Business Name): JEAN HURH L.AC, MATOM, DIPL.OM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 E GOLF RD
ARLINGTON HEIGHTS IL
60005-4008
US

IV. Provider business mailing address

342 E GOLF RD
ARLINGTON HEIGHTS IL
60005-4008
US

V. Phone/Fax

Practice location:
  • Phone: 847-427-5678
  • Fax: 847-545-1237
Mailing address:
  • Phone: 847-427-5678
  • Fax: 847-545-1237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198001551
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: