1538326665 NPI number — CHICAGO'S HIGH ACHIEVERS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538326665 NPI number — CHICAGO'S HIGH ACHIEVERS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO'S HIGH ACHIEVERS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERNATIONAL HIGH ACHIEVERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538326665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12524 S STEWART AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60628-7231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-382-8710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 E GOLF RD STE 395D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHAUMBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60173-5090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-791-4558
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CRISTERNA
Authorized Official First Name:
JINNIE
Authorized Official Middle Name:
KWON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
312-382-8710

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  060009907 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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