Healthcare Provider Details

I. General information

NPI: 1720083777
Provider Name (Legal Business Name): JONGHO HAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5999 NEW WILKE RD S-200, BLDG 2
ROLLING MEADOWS IL
60008
US

IV. Provider business mailing address

5999 NEW WILKE RD S-200, BLDG 2
ROLLING MEADOWS IL
60008-4502
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-7107
  • Fax: 847-255-7031
Mailing address:
  • Phone: 847-255-7107
  • Fax: 847-255-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036096150
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: