Provider Demographics
NPI:1093829830
Name:AN, GARY CHUN-I (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:CHUN-I
Last Name:AN
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 1:2540 W CHICAGO AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4517
Mailing Address - Country:US
Mailing Address - Phone:312-493-4872
Mailing Address - Fax:312-864-9545
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-3790
Practice Address - Fax:312-695-1462
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0870542086S0102X, 2086S0127X
VT042.00141892086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356670Medicaid
ILF63083Medicare UPIN