Healthcare Provider Details

I. General information

NPI: 1073353728
Provider Name (Legal Business Name): CHIYOKO RANDO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST STE 623
CHICAGO IL
60657-5196
US

IV. Provider business mailing address

3000 N HALSTED ST STE 623
CHICAGO IL
60657-5196
US

V. Phone/Fax

Practice location:
  • Phone: 773-281-5818
  • Fax: 773-281-6895
Mailing address:
  • Phone: 773-281-5818
  • Fax: 773-281-6895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: