Provider Demographics
NPI:1497757306
Name:MOK, CHUNG Z (MD)
Entity Type:Individual
Prefix:DR
First Name:CHUNG
Middle Name:Z
Last Name:MOK
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 1:3535 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5627
Mailing Address - Country:US
Mailing Address - Phone:773-539-5455
Mailing Address - Fax:312-326-3007
Practice Address - Street 1:3535 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5627
Practice Address - Country:US
Practice Address - Phone:773-539-5455
Practice Address - Fax:312-326-3007
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058992Medicaid
ILC45201Medicare UPIN
IL036058992Medicaid