Statewide Agency

Primary specialty

Supports Brokerage AgencyTaxonomy code 251X00000X

License

100287909 Issued in IL

Legal business name

STATEWIDE AGENCY

Practice address

1920 Waukegan Rd
Suite 5
Glenview, IL 60025-1717

Phone

(847) 724-3600

Fax

(847) 241-0202

NPI assigned

Mar 4, 2016

Last updated

Mar 4, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hak I Jin

Title

President

Phone

(847) 724-3600

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1881054757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 WAUKEGAN ROAD",
            "address_2": "SUITE 5",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "60025",
            "telephone_number": "847-724-3600",
            "fax_number": "847-241-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 WAUKEGAN RD",
            "address_2": "SUITE 5",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600251717",
            "telephone_number": "847-724-3600",
            "fax_number": "847-241-0202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-04",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "JIN",
        "authorized_official_first_name": "HAK",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-724-3600"
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "IL",
            "license": "100287909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.