Healthcare Provider Details

I. General information

NPI: 1033187414
Provider Name (Legal Business Name): CHOONG H KOH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH STREET
OAK LAWN IL
60653
US

IV. Provider business mailing address

1986 N BROADMOOR LANE
VERNON HILLS IL
60061
US

V. Phone/Fax

Practice location:
  • Phone: 708-345-5520
  • Fax:
Mailing address:
  • Phone: 847-362-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: