Healthcare Provider Details

I. General information

NPI: 1285732651
Provider Name (Legal Business Name): IN HUH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 W FOSTER AVE SUITE 309
CHICAGO IL
60625-3500
US

IV. Provider business mailing address

2740 W FOSTER AVE SUITE 309
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-3141
  • Fax: 773-769-1458
Mailing address:
  • Phone: 773-769-3141
  • Fax: 773-769-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number03653425
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: