Healthcare Provider Details

I. General information

NPI: 1700523206
Provider Name (Legal Business Name): CHAK-SUM HO PHD, F(ACHI), FAACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SPRING LAKE DR
ITASCA IL
60143-2076
US

IV. Provider business mailing address

425 SPRING LAKE DR
ITASCA IL
60143-2076
US

V. Phone/Fax

Practice location:
  • Phone: 630-758-2660
  • Fax: 630-758-2760
Mailing address:
  • Phone: 630-758-2660
  • Fax: 630-758-2760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: