Healthcare Provider Details

I. General information

NPI: 1285730606
Provider Name (Legal Business Name): DENNIS HONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/21/2022
Certification Date: 05/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE
CHICAGO IL
60616-2315
US

IV. Provider business mailing address

2525 S MICHIGAN AVE ATT: MEDICAL STAFF OFFICE
CHICAGO IL
60616-2315
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-5564
  • Fax: 312-328-7819
Mailing address:
  • Phone: 312-567-7924
  • Fax: 312-567-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036079412
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036-079412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: