Provider Demographics
NPI:1053886689
Name:HONG, JIANRONG
Entity type:Individual
Prefix:
First Name:JIANRONG
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARKWAY NORTH BLVD APT 126
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2569
Mailing Address - Country:US
Mailing Address - Phone:312-330-1579
Mailing Address - Fax:
Practice Address - Street 1:666 DUNDEE RD STE 1002
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2735
Practice Address - Country:US
Practice Address - Phone:847-714-7400
Practice Address - Fax:224-723-5546
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist