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General NPI Number Information
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NPI Number | 1366620981
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Entity Type | Organization
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Legal Business Name | PATIENT-PRACTITIONER PARTNERSHIP LLC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 2043 W 35TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-1103
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Country | US
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Telephone | 773-254-0229
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Fax | 773-254-0229
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Provider Business Mailing Address
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Address Line | 2043 W 35TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-1103
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Country | US
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Telephone | 773-254-0229
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Fax | 773-254-0229
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHU-KWAN AUGUSTINE WONG
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Credential | MD
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Telephone | 773-254-0229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | IL
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