Provider Demographics
NPI:1093735144
Name:JUN, DAVID YOUNGSIK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:YOUNGSIK
Last Name:JUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 DEMPSTER ST
Mailing Address - Street 2:SUITE #403
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8412
Mailing Address - Country:US
Mailing Address - Phone:847-627-5206
Mailing Address - Fax:847-627-5207
Practice Address - Street 1:2604 DEMPSTER ST
Practice Address - Street 2:SUITE #403
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8412
Practice Address - Country:US
Practice Address - Phone:847-627-5206
Practice Address - Fax:847-627-5207
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078305Medicaid
IL14D0973005OtherCLIA #
IL364294183OtherTAX ID EIN
ILK15090Medicare ID - Type Unspecified
IL364294183OtherTAX ID EIN