Provider Demographics
NPI:1174716500
Name:CHAE, SOOJONG HONG (MD)
Entity type:Individual
Prefix:
First Name:SOOJONG
Middle Name:HONG
Last Name:CHAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SOOJONG
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2150 PFINGSTEN RD STE 3000
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1314
Mailing Address - Country:US
Mailing Address - Phone:847-657-1900
Mailing Address - Fax:847-657-1961
Practice Address - Street 1:2150 PFINGSTEN RD STE 3000
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1314
Practice Address - Country:US
Practice Address - Phone:847-657-1900
Practice Address - Fax:847-657-1961
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007099207RG0100X
FLME108295207RG0100X
CAA95912207RG0100X
MI4301081757207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002675900Medicaid
FL149W9OtherBLUE CROSS BLUE SHIELD
FLP00928523Medicare PIN
FLDU431ZMedicare PIN