Provider Demographics
NPI:1932275633
Name:HOPE MED CLINIC, S.C.
Entity type:Organization
Organization Name:HOPE MED CLINIC, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-837-9787
Mailing Address - Street 1:2604 DEMPSTER ST STE 403
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8428
Mailing Address - Country:US
Mailing Address - Phone:847-627-5206
Mailing Address - Fax:708-942-6744
Practice Address - Street 1:2604 DEMPSTER ST STE 403
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8428
Practice Address - Country:US
Practice Address - Phone:847-627-5206
Practice Address - Fax:708-942-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0973005OtherCLIA
IL036078305Medicaid
IL=========OtherTAX ID#