Provider Demographics
NPI:1245869718
Name:KANG, CHRISTOPHER HAANSEHM (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:HAANSEHM
Last Name:KANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:HAANSEHM
Other - Middle Name:C
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:663 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6233
Mailing Address - Country:US
Mailing Address - Phone:847-346-2504
Mailing Address - Fax:
Practice Address - Street 1:1875 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:477-955-8658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.0770782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry