Provider Demographics
NPI:1760483390
Name:KUNG, JOHN I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:I
Last Name:KUNG
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 1:19801 GOVERNORS HIGHWAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1002
Mailing Address - Country:US
Mailing Address - Phone:708-957-0505
Mailing Address - Fax:708-957-0506
Practice Address - Street 1:19801 GOVERNORS HIGHWAY
Practice Address - Street 2:SUITE 160
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1002
Practice Address - Country:US
Practice Address - Phone:708-957-0505
Practice Address - Fax:708-957-0506
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059694A207X00000X
IL36112354207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525750Medicaid
IN200525750BMedicaid
IL036112354Medicaid
ILIL3377001Medicare PIN
IN192380BMedicare PIN
4571400001Medicare NSC
IN200525750BMedicaid
ILK15624Medicare PIN
IN200525750Medicaid
ILK09895Medicare PIN
IL036112354Medicaid
ILIL3379001Medicare PIN
IL6441080001Medicare NSC
CK2034Medicare PIN
ILK48382Medicare PIN