Healthcare Provider Details

I. General information

NPI: 1750376349
Provider Name (Legal Business Name): HO MYONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-7222
US

IV. Provider business mailing address

2000 OGDEN AVE
AURORA IL
60504-7222
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-6250
  • Fax: 630-978-6869
Mailing address:
  • Phone: 630-978-6250
  • Fax: 630-978-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036110763
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: