Provider Demographics
NPI:1609188101
Name:OK KYONG CHAEKAL MD LTD
Entity type:Organization
Organization Name:OK KYONG CHAEKAL MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OK KYONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAEKAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-429-9101
Mailing Address - Street 1:16532 S OAK PARK
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2268
Mailing Address - Country:US
Mailing Address - Phone:708-429-9101
Mailing Address - Fax:708-342-1465
Practice Address - Street 1:16532 S OAK PARK
Practice Address - Street 2:SUITE 102
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2268
Practice Address - Country:US
Practice Address - Phone:708-429-9101
Practice Address - Fax:708-342-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094453Medicaid
ILF33412Medicare UPIN
ILIL4053Medicare PIN
IL6456130001Medicare NSC