Provider Demographics
NPI:1619091618
Name:KUNG, MAE JEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAE
Middle Name:JEN
Last Name:KUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4858 N ROCKWELL ST
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2889
Mailing Address - Country:US
Mailing Address - Phone:312-850-0398
Mailing Address - Fax:312-850-9885
Practice Address - Street 1:1340 S CANAL ST
Practice Address - Street 2:PHARMACY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-5208
Practice Address - Country:US
Practice Address - Phone:312-850-0398
Practice Address - Fax:312-850-9885
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist