Healthcare Provider Details

I. General information

NPI: 1487677076
Provider Name (Legal Business Name): DAVID T HONG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W WASHINGTON ST SUITE 930
CHICAGO IL
60602-3580
US

IV. Provider business mailing address

180 W WASHINGTON ST SUITE 930
CHICAGO IL
60602-2301
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-2443
  • Fax: 312-263-0441
Mailing address:
  • Phone: 312-263-2443
  • Fax: 312-263-0441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number016003687
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number016003687
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: