Provider Demographics
NPI:1649240888
Name:CHUNG, DONG JOON (MD)
Entity Type:Individual
Prefix:
First Name:DONG JOON
Middle Name:
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 1:12935 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2428
Mailing Address - Country:US
Mailing Address - Phone:708-597-2000
Mailing Address - Fax:708-824-4582
Practice Address - Street 1:1011 FORD AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1701
Practice Address - Country:US
Practice Address - Phone:217-347-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38606207Q00000X
WI51131-020207Q00000X
IL036138331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34972500Medicaid
KY64083041Medicaid
KY64083041Medicaid
WI34972500Medicaid
0922006Medicare PIN
WI003337005Medicare PIN