Provider Demographics
NPI:1104989144
Name:YIM, HONG B (DC, CCSP)
Entity type:Individual
Prefix:DR
First Name:HONG
Middle Name:B
Last Name:YIM
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3259
Mailing Address - Country:US
Mailing Address - Phone:847-677-7437
Mailing Address - Fax:847-677-7454
Practice Address - Street 1:4432 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3259
Practice Address - Country:US
Practice Address - Phone:847-677-7437
Practice Address - Fax:847-677-7454
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU72629Medicare UPIN
IL507260Medicare ID - Type Unspecified