Provider Demographics
NPI:1275631574
Name:CHUNG, THOMAS TZI-CHORNG (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:TZI-CHORNG
Last Name:CHUNG
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 1:3235 VOLLMER ROAD
Mailing Address - Street 2:STE 139
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422
Mailing Address - Country:US
Mailing Address - Phone:708-798-2333
Mailing Address - Fax:708-798-3777
Practice Address - Street 1:3235 VOLLMER ROAD
Practice Address - Street 2:STE 139
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422
Practice Address - Country:US
Practice Address - Phone:708-798-2333
Practice Address - Fax:708-798-3777
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL477271Medicare ID - Type Unspecified
D12739Medicare UPIN