Provider Demographics
NPI:1184034878
Name:KYUNG, STELLA (MD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:KYUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BO SUN
Other - Middle Name:
Other - Last Name:KYUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:219-364-3610
Practice Address - Street 1:85 E US HIGHWAY 6 STE 300
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8948
Practice Address - Country:US
Practice Address - Phone:219-983-6300
Practice Address - Fax:219-983-6080
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
IN01085946A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program