Provider Demographics
NPI:1740588854
Name:JUNG IL JUN MD SC
Entity Type:Organization
Organization Name:JUNG IL JUN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNG
Authorized Official - Middle Name:I
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-423-3495
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-423-3495
Mailing Address - Fax:708-423-4411
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 11
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-423-3495
Practice Address - Fax:708-423-4411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036044252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036044252Medicaid
D12346Medicare UPIN