Provider Demographics
NPI:1679680490
Name:CHUNG, SUSIE (DDS)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 OAKTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3259
Mailing Address - Country:US
Mailing Address - Phone:847-942-3887
Mailing Address - Fax:847-677-7454
Practice Address - Street 1:4432 OAKTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3259
Practice Address - Country:US
Practice Address - Phone:847-942-3887
Practice Address - Fax:847-677-7454
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190255281223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics