Provider Demographics
NPI:1639754443
Name:CHUNG, KATHERINE YUN-MEI (MS, RDN)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:YUN-MEI
Last Name:CHUNG
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5606
Mailing Address - Country:US
Mailing Address - Phone:312-648-4666
Mailing Address - Fax:312-577-0801
Practice Address - Street 1:1030 N CLARK ST STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5467
Practice Address - Country:US
Practice Address - Phone:312-944-1030
Practice Address - Fax:312-648-0155
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164008375133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist