Healthcare Provider Details

I. General information

NPI: 1528186004
Provider Name (Legal Business Name): SANDERS HONGGOOK CHAE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CHARLES ST
ROCKFORD IL
61104-2200
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-5888
  • Fax:
Mailing address:
  • Phone: 813-821-8038
  • Fax: 813-974-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number036155107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: